Provider Demographics
NPI:1083840185
Name:MARR, JANICE ELAINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:ELAINE
Last Name:MARR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 S 152ND WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-4245
Mailing Address - Country:US
Mailing Address - Phone:918-857-7944
Mailing Address - Fax:
Practice Address - Street 1:1712 S 152ND WEST AVE
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-4245
Practice Address - Country:US
Practice Address - Phone:918-857-7944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical