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General NPI Number Information
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NPI Number | 1518465699
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Entity Type | Individual
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Provider Name | DONNA JOLLY LPC-C
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Gender | Female
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Dates
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Enumeration Date | 01/24/2018
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 4400 N LINCOLN BLVD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73105-5104
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Country | US
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Telephone | 405-766-7035
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Fax |
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Provider Business Mailing Address
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Address Line | 600 E FOREST LN
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City | MUSTANG
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State | OK
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Zip | 73064-4612
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Country | US
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Telephone | 405-927-3221
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 7486
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License Number State |
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