Provider Demographics
NPI:1750664397
Name:PLUMLEY, JESSICA LEE (PHD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:PLUMLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 W WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:NICHOLS HILLS
Mailing Address - State:OK
Mailing Address - Zip Code:73116-4115
Mailing Address - Country:US
Mailing Address - Phone:405-922-1867
Mailing Address - Fax:
Practice Address - Street 1:1300 E 9TH ST STE 5
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5760
Practice Address - Country:US
Practice Address - Phone:405-922-1867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical