Provider Demographics
NPI:1407278542
Name:OOSCO, JEREMY ROBERT (PHD MDIV LCPC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:ROBERT
Last Name:OOSCO
Suffix:
Gender:M
Credentials:PHD MDIV LCPC
Other - Prefix:DR
Other - First Name:JEREMY
Other - Middle Name:ROBERT
Other - Last Name:OROSCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD MDIV LCPC
Mailing Address - Street 1:628 SE 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73129-4904
Mailing Address - Country:US
Mailing Address - Phone:405-413-0276
Mailing Address - Fax:
Practice Address - Street 1:628 SE 30TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73129-4904
Practice Address - Country:US
Practice Address - Phone:405-413-0276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-08
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YP1600X101YP1600X
FL16544101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral