Provider Demographics
NPI:1952487555
Name:MOSLEY, JENNY MICHELLE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:MICHELLE
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:JENNY
Other - Middle Name:MICHELLE
Other - Last Name:MOSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1305 N SHARTEL AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2403
Mailing Address - Country:US
Mailing Address - Phone:405-702-6677
Mailing Address - Fax:405-702-6680
Practice Address - Street 1:1305 N SHARTEL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2403
Practice Address - Country:US
Practice Address - Phone:405-702-6677
Practice Address - Fax:405-702-6680
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2302101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor