Healthcare Provider Details

I. General information

NPI: 1013737964
Provider Name (Legal Business Name): JENEL FATIHAH LMSW-P U/S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 S FULTON AVE STE A1
TULSA OK
74135-6905
US

IV. Provider business mailing address

4901 S FULTON AVE STE A1
TULSA OK
74135-6905
US

V. Phone/Fax

Practice location:
  • Phone: 539-525-0078
  • Fax:
Mailing address:
  • Phone: 539-525-0078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: