Provider Demographics
NPI:1700302833
Name:JAMISON, GRACIE (LPC)
Entity type:Individual
Prefix:
First Name:GRACIE
Middle Name:
Last Name:JAMISON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 S SHERIDAN RD STE 401
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-7530
Mailing Address - Country:US
Mailing Address - Phone:918-212-8361
Mailing Address - Fax:
Practice Address - Street 1:5401 S SHERIDAN RD STE 401
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-7530
Practice Address - Country:US
Practice Address - Phone:918-212-8361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7137101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health