Provider Demographics
NPI:1134105109
Name:FRITZ, JERI FRITZ (PHD)
Entity Type:Individual
Prefix:DR
First Name:JERI
Middle Name:FRITZ
Last Name:FRITZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 S BOSTON AVE
Mailing Address - Street 2:STE. 311
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-1225
Mailing Address - Country:US
Mailing Address - Phone:918-584-6694
Mailing Address - Fax:918-584-6229
Practice Address - Street 1:624 S BOSTON AVE
Practice Address - Street 2:STE. 311
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-1225
Practice Address - Country:US
Practice Address - Phone:918-584-6694
Practice Address - Fax:918-584-6229
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK662103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKR85689Medicare UPIN