Provider Demographics
NPI:1023110491
Name:TUBB, JANIE (MSW)
Entity type:Individual
Prefix:
First Name:JANIE
Middle Name:
Last Name:TUBB
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 N CLASSEN BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-3231
Mailing Address - Country:US
Mailing Address - Phone:405-628-5263
Mailing Address - Fax:405-601-3750
Practice Address - Street 1:3601 N CLASSEN BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118
Practice Address - Country:US
Practice Address - Phone:405-628-5263
Practice Address - Fax:405-601-3750
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical