Healthcare Provider Details

I. General information

NPI: 1801078621
Provider Name (Legal Business Name): LURA LEA JAQUESS-WARE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 09/24/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 E 15TH ST
PAWHUSKA OK
74056-1901
US

IV. Provider business mailing address

200 ATLANTIC FIELD RD
PAWHUSKA OK
74056-4013
US

V. Phone/Fax

Practice location:
  • Phone: 918-287-3740
  • Fax:
Mailing address:
  • Phone: 918-637-7443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number202610
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: