Provider Demographics
NPI:1144423690
Name:MARINO, JENNIE MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:MARIE
Last Name:MARINO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 CORNWALL PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-4308
Mailing Address - Country:US
Mailing Address - Phone:405-842-2439
Mailing Address - Fax:
Practice Address - Street 1:1700 W BRITTON RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-1312
Practice Address - Country:US
Practice Address - Phone:405-848-9393
Practice Address - Fax:405-848-9310
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3355101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional