Provider Demographics
NPI:1376866715
Name:FEUERBORN, JAN K (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:K
Last Name:FEUERBORN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 E TONHAWA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-7209
Mailing Address - Country:US
Mailing Address - Phone:405-627-4608
Mailing Address - Fax:405-701-3399
Practice Address - Street 1:123 E TONHAWA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-7209
Practice Address - Country:US
Practice Address - Phone:405-627-4608
Practice Address - Fax:405-701-3399
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3307101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200345190AMedicaid