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General NPI Number Information
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NPI Number | 1821323718
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Entity Type | Individual
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Provider Name | JENNIFER C MCGLOTHLIN CADC
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Gender | Female
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Dates
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Enumeration Date | 10/09/2009
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 606 KIHEKAH AVE
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City | PAWHUSKA
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State | OK
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Zip | 74056
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Country | US
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Telephone | 918-287-5414
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Fax |
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Provider Business Mailing Address
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Address Line | 468 85TH RD
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City | PONCA CITY
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State | OK
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Zip | 74604-6675
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Country | US
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Telephone | 580-765-9511
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 430
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License Number State | OK
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