Provider Demographics
NPI:1003174608
Name:JANICE L. HENDRYX
Entity Type:Organization
Organization Name:JANICE L. HENDRYX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENDRYX
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:405-517-7612
Mailing Address - Street 1:7244 NW 129TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-2544
Mailing Address - Country:US
Mailing Address - Phone:405-517-7612
Mailing Address - Fax:405-603-6624
Practice Address - Street 1:3908 N PENIEL AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-3458
Practice Address - Country:US
Practice Address - Phone:405-603-3265
Practice Address - Fax:405-603-6624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK42051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200362380BMedicaid