Healthcare Provider Details

I. General information

NPI: 1942578406
Provider Name (Legal Business Name): JENNIFER RANKIN MA, LPC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 W MEMORIAL RD STE 503
OKLAHOMA CITY OK
73120-8305
US

IV. Provider business mailing address

4200 W MEMORIAL RD STE 503
OKLAHOMA CITY OK
73120-8305
US

V. Phone/Fax

Practice location:
  • Phone: 405-254-3131
  • Fax: 405-254-3133
Mailing address:
  • Phone: 405-254-3131
  • Fax: 405-254-3133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4609
License Number StateOK

VIII. Authorized Official

Name: MRS. JENNIFER RANKIN
Title or Position: OWNER
Credential: MA, LPC
Phone: 405-254-3131