Provider Demographics
NPI:1356496384
Name:BRENTS, JENNIFER GRACE (LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GRACE
Last Name:BRENTS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-3863
Mailing Address - Country:US
Mailing Address - Phone:580-326-8098
Mailing Address - Fax:580-326-6400
Practice Address - Street 1:117 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-6237
Practice Address - Country:US
Practice Address - Phone:580-326-7477
Practice Address - Fax:580-326-6400
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2553101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health