Basic Information
Provider Information
NPI: 1588936512
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: SARAH
MiddleName: ALISON
NamePrefix: DR.
NameSuffix:  
Credential: PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5110 S YALE AVE
Address2: SUITE 103
City: TULSA
State: OK
PostalCode: 741357401
CountryCode: US
TelephoneNumber: 9187797637
FaxNumber: 9189386037
Practice Location
Address1: 5110 S YALE AVE
Address2: SUITE 103
City: TULSA
State: OK
PostalCode: 741357401
CountryCode: US
TelephoneNumber: 9187797637
FaxNumber: 9189386037
Other Information
ProviderEnumerationDate: 02/07/2012
LastUpdateDate: 01/28/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC2200X1169OKY Behavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent

No ID Information.


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