Provider Demographics
NPI:1609465863
Name:JAJA, CATHERINE (SOLE PROPRIETOR)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:JAJA
Suffix:
Gender:F
Credentials:SOLE PROPRIETOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 AMBERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-2125
Mailing Address - Country:US
Mailing Address - Phone:405-816-2756
Mailing Address - Fax:
Practice Address - Street 1:131 AMBERWOOD RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-2125
Practice Address - Country:US
Practice Address - Phone:405-816-2756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health