Basic Information
| Provider Information | |||||||||
| NPI: | 1720336142 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENTING | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | ROBERT | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PSY.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 550 S PEORIA AVENUE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741203820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185881900 | ||||||||
| FaxNumber: | 9185826405 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 S PEORIA AVENUE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741203820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185881900 | ||||||||
| FaxNumber: | 9185826405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2012 | ||||||||
| LastUpdateDate: | 01/27/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 1218 | OK | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 73-1042545 | 01 | OK | GROUP MEDICARE | OTHER | 73-1042545 | 01 | OK | GROUP BCBS | OTHER | 731042545001 | 01 | OK | GROUP TRICARE | OTHER | 100732910-G | 01 | OK | GROUP MEDICAID/SOONERCARE | OTHER | 73-1042545 | 01 | OK | GROUP COMMUNITY CARE OF OKLAHOMA | OTHER | 100732910-A | 01 | OK | GROUP MEDICAID/SOONERCARE | OTHER |