Provider Demographics
NPI:1356896237
Name:STAPLETON, JESSE WAYNE (LCSW)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:WAYNE
Last Name:STAPLETON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1194
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:OK
Mailing Address - Zip Code:74346-1194
Mailing Address - Country:US
Mailing Address - Phone:918-253-4539
Mailing Address - Fax:
Practice Address - Street 1:337 S MAIN ST
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:OK
Practice Address - Zip Code:74346-3801
Practice Address - Country:US
Practice Address - Phone:918-253-4539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK77351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical