Provider Demographics
NPI:1669817508
Name:DAWES, JILLIAN (BA)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:DAWES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 W 19TH AVE
Mailing Address - Street 2:APT K2
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-1660
Mailing Address - Country:US
Mailing Address - Phone:918-348-1450
Mailing Address - Fax:
Practice Address - Street 1:540 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:PAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74058-2036
Practice Address - Country:US
Practice Address - Phone:918-762-1045
Practice Address - Fax:918-762-2214
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor