Provider Demographics
NPI:1063849263
Name:MATNEY, JANIE LEANN
Entity Type:Individual
Prefix:MRS
First Name:JANIE
Middle Name:LEANN
Last Name:MATNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JANIE
Other - Middle Name:LEANN
Other - Last Name:TATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1164
Mailing Address - Street 2:
Mailing Address - City:KELLYVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74039-1164
Mailing Address - Country:US
Mailing Address - Phone:918-855-0697
Mailing Address - Fax:
Practice Address - Street 1:15155 ENGLISH RD
Practice Address - Street 2:
Practice Address - City:MOUNDS
Practice Address - State:OK
Practice Address - Zip Code:74047-3937
Practice Address - Country:US
Practice Address - Phone:918-855-0697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor