Basic Information
| Provider Information | |||||||||
| NPI: | 1801319652 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARNES | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | D | ||||||||
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| OtherLastName: | BARNES | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | D | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | LCSW | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 707001 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741707001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185028013 | ||||||||
| FaxNumber: | 9185028002 | ||||||||
| Practice Location | |||||||||
| Address1: | 735 N FOREMAN ST | ||||||||
| Address2: | |||||||||
| City: | VINITA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 743011422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182569201 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 5454 | OK | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.