Provider Demographics
NPI:1598488900
Name:DURHAM, JENNIFER (LMSW-PROVISIONAL)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DURHAM
Suffix:
Gender:F
Credentials:LMSW-PROVISIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 JUDY DR
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-4551
Mailing Address - Country:US
Mailing Address - Phone:405-889-7087
Mailing Address - Fax:
Practice Address - Street 1:5009 JUDY DR
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-4551
Practice Address - Country:US
Practice Address - Phone:405-889-7087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8750-P104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker