Provider Demographics
NPI:1346848470
Name:SPENCER, ANNAMARIE GLENDA JEWELL (MA)
Entity Type:Individual
Prefix:
First Name:ANNAMARIE
Middle Name:GLENDA JEWELL
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ANNAMARIE
Other - Middle Name:GLENDA JEWELL
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:408 HERITAGE GREEN RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-2128
Mailing Address - Country:US
Mailing Address - Phone:405-315-0052
Mailing Address - Fax:
Practice Address - Street 1:4911 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-6171
Practice Address - Country:US
Practice Address - Phone:405-751-0800
Practice Address - Fax:405-751-6488
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health