Provider Demographics
NPI:1114244589
Name:WASHINGTON, JESSYCA JEAN (BHRS)
Entity Type:Individual
Prefix:MISS
First Name:JESSYCA
Middle Name:JEAN
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4801 N CLASSEN BLVD
Mailing Address - Street 2:STE 159
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-4627
Mailing Address - Country:US
Mailing Address - Phone:405-607-6670
Mailing Address - Fax:405-607-6671
Practice Address - Street 1:4801 N CLASSEN BLVD
Practice Address - Street 2:STE 159
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4627
Practice Address - Country:US
Practice Address - Phone:405-607-6670
Practice Address - Fax:405-607-6671
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKJ081959238104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker