Provider Demographics
NPI:1275781973
Name:BLUE, JENNIFER FONS (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:FONS
Last Name:BLUE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:DORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6922 S WESTERN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-1803
Mailing Address - Country:US
Mailing Address - Phone:405-632-2815
Mailing Address - Fax:
Practice Address - Street 1:6922 S WESTERN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-1803
Practice Address - Country:US
Practice Address - Phone:405-632-2815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2569101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor