Provider Demographics
NPI:1831494947
Name:JATTA, OPHELIA
Entity Type:Individual
Prefix:MS
First Name:OPHELIA
Middle Name:
Last Name:JATTA
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 1:1313 N STONECROP DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-2360
Mailing Address - Country:US
Mailing Address - Phone:405-501-2169
Mailing Address - Fax:
Practice Address - Street 1:1000 W WILSHIRE BLVD
Practice Address - Street 2:SUITE 403E
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7030
Practice Address - Country:US
Practice Address - Phone:405-879-3443
Practice Address - Fax:405-879-3446
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator