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General NPI Number Information
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NPI Number | 1578383063
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Entity Type | Organization
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Legal Business Name | JG MENTAL HEALTH PLLC
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 4334 NW EXPRESSWAY STE 108
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-1515
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Country | US
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Telephone | 405-414-2826
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Fax |
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Provider Business Mailing Address
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Address Line | 7508 NW 103RD ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73162-4408
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JONATHAN GRANT
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Credential |
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Telephone | 405-414-2826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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