Basic Information
| Provider Information | |||||||||
| NPI: | 1881891919 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEORGE | ||||||||
| FirstName: | JANET | ||||||||
| MiddleName: | JANETTE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | BACHELOR'S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1529 SW 131ST TER | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731706995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058959906 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 624 NW 5TH ST | ||||||||
| Address2: | |||||||||
| City: | MOORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731603924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057993379 | ||||||||
| FaxNumber: | 4057990912 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 101Y00000X | X | Behavioral Health & Social Service Providers | Counselor | 171M00000X | X | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.