Healthcare Provider Details

I. General information

NPI: 1699030916
Provider Name (Legal Business Name): JENNIFER D COLEMAN WILSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W I 240 SERVICE RD
OKLAHOMA CITY OK
73139-7701
US

IV. Provider business mailing address

430 W WILSHIRE BLVD
OKLAHOMA CITY OK
73116-7771
US

V. Phone/Fax

Practice location:
  • Phone: 405-424-7711
  • Fax:
Mailing address:
  • Phone: 405-761-4970
  • Fax: 405-521-8652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11272
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11272
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: