Provider Demographics
NPI:1821734948
Name:JETT, VALARI
Entity Type:Individual
Prefix:
First Name:VALARI
Middle Name:
Last Name:JETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W MAIN ST STE 140
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-6321
Mailing Address - Country:US
Mailing Address - Phone:158-022-4292
Mailing Address - Fax:
Practice Address - Street 1:624 W INDEPENDENCE ST STE 113-115
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-4306
Practice Address - Country:US
Practice Address - Phone:405-585-6064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor