Provider Demographics
NPI:1760451926
Name:JACKMAN, ELIZABETH A (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:JACKMAN
Suffix:
Gender:F
Credentials:LCSW
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Other - Credentials:
Mailing Address - Street 1:PO BOX 21228
Mailing Address - Street 2:DEPARTMENT 31
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121-1228
Mailing Address - Country:US
Mailing Address - Phone:918-488-6001
Mailing Address - Fax:918-502-7825
Practice Address - Street 1:6655 S YALE AVE
Practice Address - Street 2:LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3326
Practice Address - Country:US
Practice Address - Phone:918-491-3762
Practice Address - Fax:918-491-5740
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK21401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2238115OtherCIGNA BEHAVIORAL HEALTH
OKOK400985Medicare PIN