Provider Demographics
NPI:1265673636
Name:HENDRYX, JANICE L
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:L
Last Name:HENDRYX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:L
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:7244 NW 129TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-2544
Mailing Address - Country:US
Mailing Address - Phone:405-517-7612
Mailing Address - Fax:405-603-6624
Practice Address - Street 1:3908 N PENIEL AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-3458
Practice Address - Country:US
Practice Address - Phone:405-603-3265
Practice Address - Fax:405-603-6624
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK42051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200362380BMedicaid