Provider Demographics
NPI:1578702577
Name:JENNIFER CREMIN SELLERS, PLLC
Entity Type:Organization
Organization Name:JENNIFER CREMIN SELLERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:CREMIN
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:918-724-3831
Mailing Address - Street 1:11421 S JOPLIN AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-7753
Mailing Address - Country:US
Mailing Address - Phone:918-298-3831
Mailing Address - Fax:
Practice Address - Street 1:6853 S CANTON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3405
Practice Address - Country:US
Practice Address - Phone:918-496-8050
Practice Address - Fax:918-496-9597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty