MEDICARE: JENNIFER MCDONALD

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	101YM0800X	Mental Health Counselor		OK

General Provider Information

NPI Number	:	1881207306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MCDONALD

Provider Business Mailing Address
First Line	:	9814 E 21ST PL APT B
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74129-3811
Country	:	US
Telephone Number	:	539-292-5694
Fax Number	:

Provider Business Practice Location Address
First Line	:	9804 E 21ST PL APT A
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74129-3815
Country	:	US
Telephone Number	:	405-919-8781
Fax Number	:

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

Provider Enumeration Date	:	08/25/2020
Last Update Date	:	08/25/2020

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