Provider Demographics
NPI:1770237240
Name:RASE, JESSICA HELEN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:HELEN
Last Name:RASE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:HELEN
Other - Last Name:LANDIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 W 6TH ST STE 1211
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-5406
Mailing Address - Country:US
Mailing Address - Phone:918-295-5055
Mailing Address - Fax:
Practice Address - Street 1:15 W 6TH ST STE 1211
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-5406
Practice Address - Country:US
Practice Address - Phone:918-295-5055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health