Provider Demographics
NPI:1851899371
Name:DOYLE, JENNIFER C (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:DOYLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12444 N.W. 10TH STREET
Mailing Address - Street 2:SUITE 202 PMB 204
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099
Mailing Address - Country:US
Mailing Address - Phone:918-208-8645
Mailing Address - Fax:405-632-1976
Practice Address - Street 1:11217 W. RENO AVE.
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099
Practice Address - Country:US
Practice Address - Phone:918-208-8645
Practice Address - Fax:405-632-1976
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OK7518LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health