MEDICARE: MRS. JENNIFER FONS BLUE MS, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	2569	OK
2	101YM0800X	Mental Health Counselor	2569	OK

General Provider Information

NPI Number	:	1275781973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER FONS BLUE MS, LPC

Provider Business Mailing Address
First Line	:	6922 S WESTERN AVE
Second Line	:	SUITE 101
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-1803
Country	:	US
Telephone Number	:	405-632-2815
Fax Number	:

Provider Business Practice Location Address
First Line	:	6922 S WESTERN AVE
Second Line	:	SUITE 101
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-1803
Country	:	US
Telephone Number	:	405-632-2815
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2008
Last Update Date	:	02/20/2019

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