Provider Demographics
NPI:1184985749
Name:JAURDON, ENRICO MIGUEL (MA,)
Entity type:Individual
Prefix:MR
First Name:ENRICO
Middle Name:MIGUEL
Last Name:JAURDON
Suffix:
Gender:M
Credentials:MA,
Other - Prefix:
Other - First Name:RICO
Other - Middle Name:MIGUEL
Other - Last Name:JAURDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA,
Mailing Address - Street 1:625 NW 112TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-6837
Mailing Address - Country:US
Mailing Address - Phone:405-413-7856
Mailing Address - Fax:
Practice Address - Street 1:2828 NW 57TH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-6814
Practice Address - Country:US
Practice Address - Phone:405-840-1243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor