Provider Demographics
NPI:1356619431
Name:NELSON, JAYNEE MARIE (LPC, LADC/MH)
Entity type:Individual
Prefix:MS
First Name:JAYNEE
Middle Name:MARIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:LPC, LADC/MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 SW WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-7231
Mailing Address - Country:US
Mailing Address - Phone:580-678-6660
Mailing Address - Fax:405-735-6116
Practice Address - Street 1:2305 SW H AVE
Practice Address - Street 2:1
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-8103
Practice Address - Country:US
Practice Address - Phone:580-678-6660
Practice Address - Fax:405-735-6116
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1249101YA0400X
OK7051101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)