MEDICARE: JAMIE WORSTELL WOHLETZ 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	10760	OK

General Provider Information

NPI Number	:	1952944803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE WORSTELL WOHLETZ LPC

Provider Business Mailing Address
First Line	:	1912 LAKE RD
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74604-4800
Country	:	US
Telephone Number	:	580-763-1902
Fax Number	:

Provider Business Practice Location Address
First Line	:	1912 LAKE RD
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74604-4800
Country	:	US
Telephone Number	:	580-763-1902
Fax Number	:

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

Provider Enumeration Date	:	10/23/2019
Last Update Date	:	01/04/2024

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