Doctor Name: | JENNIFER NICOLE STANDRIDGE |
NPI Number: | 1447699905 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 512 E 24th St Tishomingo, OK - 734603214 |
Business Phone Number: | 5803713672 |
Business Fax Number: | 5803713651 |
Mailing Address: | Po Box 48, MEAD |
State: | OK |
Postal Code: | 734490048 |
Phone Number: | 5807459610 |
Fax Number: | 5807459891 |
NPI Enumeration Date: | 06/18/2013 |
NPI Last Update Date: | 06/18/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |