Provider Demographics
NPI:1316212350
Name:ENGLAND, JERRED ALLEN
Entity Type:Individual
Prefix:
First Name:JERRED
Middle Name:ALLEN
Last Name:ENGLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 S MIDWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4642
Mailing Address - Country:US
Mailing Address - Phone:405-733-5437
Mailing Address - Fax:
Practice Address - Street 1:3917 E. MEMORIAL RD.
Practice Address - Street 2:SUITE A
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-7230
Practice Address - Country:US
Practice Address - Phone:405-317-5667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist