Basic Information
| Provider Information | |||||||||
| NPI: | 1225398332 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JARIA | ||||||||
| FirstName: | BERNICE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1321 SW 27TH ST | ||||||||
| Address2: | APARTMENT 3 | ||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735057951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615948391 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4411 W GORE BLVD | ||||||||
| Address2: | SUITE B8 | ||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735055977 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5806955596 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2012 | ||||||||
| LastUpdateDate: | 05/22/2012 | ||||||||
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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.