Provider Demographics
NPI:1487981023
Name:DAVIES, JENNIFER DARLENE (BA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DARLENE
Last Name:DAVIES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12745 DUBOISE RD
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:OK
Mailing Address - Zip Code:74932-2092
Mailing Address - Country:US
Mailing Address - Phone:918-654-3425
Mailing Address - Fax:
Practice Address - Street 1:309 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4227
Practice Address - Country:US
Practice Address - Phone:918-647-5395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst