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NPI Code Detail

MEDICARE: MRS. JEANNEROSA DEPAZ LAY MS, CM-A

MEDICARE: MRS. JEANNEROSA DEPAZ LAY MS, CM-A
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1487856126
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JEANNEROSA DEPAZ LAY MS, CM-A
Provider Business Mailing Address
First Line : 2010 BOREN BLVD
Second Line :
City : SEMINOLE
State : OK
Zip : 74868-2050
Country : US
Telephone Number : 405-382-4507
Fax Number : 405-382-5269
Provider Business Practice Location Address
First Line : 2010 BOREN BLVD
Second Line :
City : SEMINOLE
State : OK
Zip : 74868-2050
Country : US
Telephone Number : 405-382-4507
Fax Number : 405-382-5269
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2007
Last Update Date : 03/06/2024

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