MEDICARE: MRS. JODIE L. MCKLEROY M.ED, 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	101YP2500X	Professional Counselor	2987	OK

General Provider Information

NPI Number	:	1710293840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JODIE L. MCKLEROY M.ED, LPC

Provider Business Mailing Address
First Line	:	5213 NW 111TH TER
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-3713
Country	:	US
Telephone Number	:	405-722-0848
Fax Number	:

Provider Business Practice Location Address
First Line	:	5213 NW 111TH TER
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-3713
Country	:	US
Telephone Number	:	405-722-0848
Fax Number	:

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

Provider Enumeration Date	:	08/26/2010
Last Update Date	:	08/26/2010

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