Provider Demographics
NPI:1649516709
Name:QUEEN, JENIFER ANNE (LPC-S, NCC)
Entity type:Individual
Prefix:MS
First Name:JENIFER
Middle Name:ANNE
Last Name:QUEEN
Suffix:
Gender:F
Credentials:LPC-S, NCC
Other - Prefix:MS
Other - First Name:JENIFER
Other - Middle Name:ANNE
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:5332 S MEMORIAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-9000
Mailing Address - Country:US
Mailing Address - Phone:918-895-8044
Mailing Address - Fax:918-895-8056
Practice Address - Street 1:5332 S MEMORIAL DR STE 300
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-9000
Practice Address - Country:US
Practice Address - Phone:918-895-8044
Practice Address - Fax:918-895-8056
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4769101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional