Provider Demographics
NPI:1992864847
Name:MATA, JANE F (LMFT)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:F
Last Name:MATA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4334 NW EXPRESSWAY STE 247
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1576
Mailing Address - Country:US
Mailing Address - Phone:405-226-0277
Mailing Address - Fax:405-286-1380
Practice Address - Street 1:4334 NW EXPRESSWAY STE 247
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1576
Practice Address - Country:US
Practice Address - Phone:405-226-0277
Practice Address - Fax:405-286-1380
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK830106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist