Provider Demographics
NPI:1851667406
Name:NEWMAN, JILL
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:NEWMAN
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 1:44038 45TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-9683
Mailing Address - Country:US
Mailing Address - Phone:405-827-2514
Mailing Address - Fax:405-584-4038
Practice Address - Street 1:44038 45TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-9683
Practice Address - Country:US
Practice Address - Phone:405-337-0055
Practice Address - Fax:405-584-4038
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200425100BMedicaid