Provider Demographics
NPI:1518688159
Name:JEANINE SOMERS, LLC
Entity Type:Organization
Organization Name:JEANINE SOMERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:RIDENER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:405-326-1772
Mailing Address - Street 1:3839 S BOULEVARD STE 200
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5495
Mailing Address - Country:US
Mailing Address - Phone:405-326-1772
Mailing Address - Fax:
Practice Address - Street 1:3839 S BOULEVARD STE 200
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5495
Practice Address - Country:US
Practice Address - Phone:405-326-1772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty