Provider Demographics
NPI:1013232727
Name:JONES PORTER, VERONICA ANN (BS)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:ANN
Last Name:JONES PORTER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 S GARNETT RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-5121
Mailing Address - Country:US
Mailing Address - Phone:918-594-2396
Mailing Address - Fax:918-794-3735
Practice Address - Street 1:2326 S GARNETT RD
Practice Address - Street 2:SUITE E
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-5121
Practice Address - Country:US
Practice Address - Phone:918-594-2396
Practice Address - Fax:918-794-3735
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YP1600X
OK22086171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral