Basic Information
| Provider Information | |||||||||
| NPI: | 1801195987 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAIRRELL | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | B.A., REHAB SPEC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 357 | ||||||||
| Address2: | |||||||||
| City: | CLAYTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 745360357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185104840 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 301 N HIGH ST | ||||||||
| Address2: | |||||||||
| City: | ANTLERS | ||||||||
| State: | OK | ||||||||
| PostalCode: | 745232238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802985779 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2011 | ||||||||
| LastUpdateDate: | 08/23/2011 | ||||||||
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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 | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.