Provider Demographics
NPI:1285838409
Name:THORNTON, JACQUELINE M (CASE MANAGER)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:M
Last Name:THORNTON
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:MRS
Other - First Name:JACKIE
Other - Middle Name:M
Other - Last Name:THORNTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5408 N STONEWALL DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-6656
Mailing Address - Country:US
Mailing Address - Phone:405-427-6024
Mailing Address - Fax:405-427-0015
Practice Address - Street 1:5131 N CLASSEN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-5258
Practice Address - Country:US
Practice Address - Phone:405-767-1126
Practice Address - Fax:405-767-6285
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK9603OtherCASE MANAGER