Provider Demographics
NPI:1184946592
Name:SCHMIDT - GOODRICH, JENNIFER LYNNE (LPC, LADC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNNE
Last Name:SCHMIDT - GOODRICH
Suffix:
Gender:F
Credentials:LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 NE 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-1811
Mailing Address - Country:US
Mailing Address - Phone:405-235-7537
Mailing Address - Fax:405-528-5754
Practice Address - Street 1:201 NE 50TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-1811
Practice Address - Country:US
Practice Address - Phone:405-235-7537
Practice Address - Fax:405-528-5754
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK732101YA0400X
OK1685101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)