Basic Information
| Provider Information | |||||||||
| NPI: | 1427428630 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRANT | ||||||||
| FirstName: | JAREE | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N 5TH ST | ||||||||
| Address2: | |||||||||
| City: | HUGO | ||||||||
| State: | OK | ||||||||
| PostalCode: | 747434005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803269475 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2510 CHICKASAW BLVD. | ||||||||
| Address2: | CHICKASAW NATION ARDMORE HEALTH CLINIC | ||||||||
| City: | ARDMORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802268181 | ||||||||
| FaxNumber: | 5804216283 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2015 | ||||||||
| LastUpdateDate: | 09/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.