Provider Demographics
NPI:1144428723
Name:COLL, JEAN E (C-RSS)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:E
Last Name:COLL
Suffix:
Gender:F
Credentials:C-RSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 E PERKINS AVE
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-3226
Mailing Address - Country:US
Mailing Address - Phone:918-227-2418
Mailing Address - Fax:
Practice Address - Street 1:15 E DEWEY AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4201
Practice Address - Country:US
Practice Address - Phone:918-227-2016
Practice Address - Fax:918-227-1125
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X-COUNSELOR101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor