Provider Demographics
NPI:1265725667
Name:GUERRA, JENNIFER (LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GUERRA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 W SUTHERLAND ST
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-3647
Mailing Address - Country:US
Mailing Address - Phone:580-471-4743
Mailing Address - Fax:
Practice Address - Street 1:1400 SE 4TH ST STE A
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-7328
Practice Address - Country:US
Practice Address - Phone:405-837-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6445101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional