Healthcare Provider Details

I. General information

NPI: 1548670102
Provider Name (Legal Business Name): JEAN LETITIA CAMMON M.A., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: J. LETITIA CAMMON M.A., LPC

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4122 W 55TH PL SUITE 119
TULSA OK
74107-9108
US

IV. Provider business mailing address

PO BOX 702504
TULSA OK
74170-2504
US

V. Phone/Fax

Practice location:
  • Phone: 918-486-9996
  • Fax: 800-260-7966
Mailing address:
  • Phone: 918-486-9996
  • Fax: 800-260-7966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4182
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: