Provider Demographics
NPI:1669532792
Name:MATHESON, JANET MARIE (MS LPC)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:MARIE
Last Name:MATHESON
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74604-1918
Mailing Address - Country:US
Mailing Address - Phone:580-765-2639
Mailing Address - Fax:580-765-2581
Practice Address - Street 1:1918 LAKE ROAD
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74604-1918
Practice Address - Country:US
Practice Address - Phone:580-765-2639
Practice Address - Fax:580-765-2581
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1185101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor