Basic Information
| Provider Information | |||||||||
| NPI: | 1437636073 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEAL | ||||||||
| FirstName: | JESSI | ||||||||
| MiddleName: | NICHOL | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW U/S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 W. MAIN ST. | ||||||||
| Address2: | |||||||||
| City: | BARNSDALL | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188473527 | ||||||||
| FaxNumber: | 9187779018 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 W. MAIN ST. | ||||||||
| Address2: | |||||||||
| City: | BARNSDALL | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188473527 | ||||||||
| FaxNumber: | 9187779018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2018 | ||||||||
| LastUpdateDate: | 07/26/2018 | ||||||||
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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 | 1041C0700X | 6301 | OK | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.