Provider Demographics
NPI:1366648545
Name:JARRELL, SALLY A
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:A
Last Name:JARRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:A
Other - Last Name:GOSSETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1815 W GORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-3614
Mailing Address - Country:US
Mailing Address - Phone:580-512-4107
Mailing Address - Fax:
Practice Address - Street 1:1815 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3614
Practice Address - Country:US
Practice Address - Phone:580-512-4107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1290106H00000X
225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist