Provider Demographics
NPI:1578801361
Name:WILSON, JASMINE
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13600 E 86TH ST N STE 100
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-8732
Mailing Address - Country:US
Mailing Address - Phone:918-272-9313
Mailing Address - Fax:918-403-6311
Practice Address - Street 1:13600 E 86TH ST N STE 100
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-8732
Practice Address - Country:US
Practice Address - Phone:918-272-9313
Practice Address - Fax:918-403-6311
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor