Provider Demographics
NPI:1427538990
Name:RUSSO, JESSICA NICOLE (MS, LPC, NCC, RPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:RUSSO
Suffix:
Gender:F
Credentials:MS, LPC, NCC, RPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:NICOLE
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC, NCC, RPT-S
Mailing Address - Street 1:2300 MCKOWN DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-6678
Mailing Address - Country:US
Mailing Address - Phone:405-321-3600
Mailing Address - Fax:
Practice Address - Street 1:2300 MCKOWN DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-6678
Practice Address - Country:US
Practice Address - Phone:405-321-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76423101YM0800X
OK11486101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health