Provider Demographics
NPI:1972830370
Name:HARDISON, JERMAINE (BHRS)
Entity Type:Individual
Prefix:
First Name:JERMAINE
Middle Name:
Last Name:HARDISON
Suffix:
Gender:M
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4149 HIGHLINE BLVD
Mailing Address - Street 2:SUITE 380
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-2103
Mailing Address - Country:US
Mailing Address - Phone:405-942-7650
Mailing Address - Fax:405-942-7686
Practice Address - Street 1:4149 HIGHLINE BLVD
Practice Address - Street 2:SUITE 380
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-2103
Practice Address - Country:US
Practice Address - Phone:405-942-7650
Practice Address - Fax:405-942-7686
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor