Provider Demographics
NPI:1205827292
Name:HALTER, JENNIFER L T (ACSW, QCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L T
Last Name:HALTER
Suffix:
Gender:F
Credentials:ACSW, QCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 NE 13TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104
Mailing Address - Country:US
Mailing Address - Phone:405-456-1000
Mailing Address - Fax:405-456-1538
Practice Address - Street 1:921 NE 13TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-456-1000
Practice Address - Fax:405-456-1538
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical