Provider Demographics
NPI:1225058571
Name:ANDERSON, JEANETTE D (LPC)
Entity Type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:D
Last Name:ANDERSON
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:PO BOX 720457
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-4336
Mailing Address - Country:US
Mailing Address - Phone:580-993-0001
Mailing Address - Fax:405-681-9081
Practice Address - Street 1:2129 SW 59TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119
Practice Address - Country:US
Practice Address - Phone:405-713-4855
Practice Address - Fax:405-681-9081
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional