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General NPI Number Information
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NPI Number | 1376128702
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Entity Type | Organization
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Legal Business Name | TRACEY M. JENNINGS, LCSW, LLC
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Dates
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Enumeration Date | 03/17/2021
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Last Update Date | 03/17/2021
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Provider Practice Location Address
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Address Line | 8516 E 101ST ST STE E
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City | TULSA
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State | OK
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Zip | 74133-7035
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Country | US
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Telephone | 918-902-3848
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Fax |
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Provider Business Mailing Address
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Address Line | 8516 E 101ST ST STE E
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City | TULSA
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State | OK
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Zip | 74133-7035
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Country | US
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Telephone | 918-902-3848
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TRACEY M JENNINGS
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Credential | LCSW, LADC
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Telephone | 918-852-1286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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