Provider Demographics
NPI:1033817820
Name:PRICE, JESSE LEE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:LEE
Last Name:PRICE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W 2ND ST, TAHLEQUAH, OK 74464, UNITED STATES
Mailing Address - Street 2:107
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-6002
Mailing Address - Country:US
Mailing Address - Phone:918-708-1755
Mailing Address - Fax:
Practice Address - Street 1:107 W 2ND ST, TAHLEQUAH, OK 74464, UNITED STATES
Practice Address - Street 2:107
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-7446
Practice Address - Country:US
Practice Address - Phone:918-708-1755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist