Provider Demographics
NPI:1548399769
Name:JETT, KEVIN (LMFT, LADC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:JETT
Suffix:
Gender:M
Credentials:LMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74802-0518
Mailing Address - Country:US
Mailing Address - Phone:405-214-5101
Mailing Address - Fax:405-878-4690
Practice Address - Street 1:26 FATHER JOE MURPHY DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-8663
Practice Address - Country:US
Practice Address - Phone:405-214-5101
Practice Address - Fax:405-878-4690
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK242101YA0400X
OK776101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)