Provider Demographics
NPI:1356672265
Name:MANLEY, JENNIFER J (LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:MANLEY
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 1:7446 S ATLANTA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5503
Mailing Address - Country:US
Mailing Address - Phone:918-851-8958
Mailing Address - Fax:
Practice Address - Street 1:7449 S WINSTON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6119
Practice Address - Country:US
Practice Address - Phone:918-851-8958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-18
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional