Provider Demographics
NPI:1013218064
Name:LEGGETT, JENNIFER GRACE (LPC, LADC, CPRSS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GRACE
Last Name:LEGGETT
Suffix:
Gender:F
Credentials:LPC, LADC, CPRSS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:GRACE
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:114 W DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:NOWATA
Mailing Address - State:OK
Mailing Address - Zip Code:74048-2601
Mailing Address - Country:US
Mailing Address - Phone:918-533-6876
Mailing Address - Fax:
Practice Address - Street 1:114 W DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:NOWATA
Practice Address - State:OK
Practice Address - Zip Code:74048
Practice Address - Country:US
Practice Address - Phone:918-533-6876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist