Healthcare Provider Details

I. General information

NPI: 1932336146
Provider Name (Legal Business Name): JENNIFIER PRICE, LPC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4612 S HARVARD AVE STE A
TULSA OK
74135-2908
US

IV. Provider business mailing address

4612 S HARVARD AVE STE A
TULSA OK
74135-2908
US

V. Phone/Fax

Practice location:
  • Phone: 918-747-5565
  • Fax: 918-747-5568
Mailing address:
  • Phone: 918-747-5565
  • Fax: 918-747-5568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3233
License Number StateOK

VIII. Authorized Official

Name: JENNIFIER LYNN PRICE
Title or Position: OWNER
Credential: LPC
Phone: 918-747-5565