Provider Demographics
NPI:1760784813
Name:MOTLEY, JILDA DEAN (DOCTORATE, LPC, NBCC)
Entity Type:Individual
Prefix:MRS
First Name:JILDA
Middle Name:DEAN
Last Name:MOTLEY
Suffix:
Gender:F
Credentials:DOCTORATE, LPC, NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 W. NEWTON PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127
Mailing Address - Country:US
Mailing Address - Phone:918-232-0154
Mailing Address - Fax:918-584-5413
Practice Address - Street 1:2301 W. NEWTON PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127
Practice Address - Country:US
Practice Address - Phone:918-232-0154
Practice Address - Fax:918-584-5413
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1675101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1675OtherL.P.C.