Provider Demographics
NPI:1114597887
Name:WHITMIRE, JARED DANIEL
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:DANIEL
Last Name:WHITMIRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7935 E 57TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-8622
Mailing Address - Country:US
Mailing Address - Phone:918-519-4642
Mailing Address - Fax:
Practice Address - Street 1:7935 E 57TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-8622
Practice Address - Country:US
Practice Address - Phone:918-519-4642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10095101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional