Provider Demographics
NPI:1689900797
Name:CAIN, JENNIFER L BRISTOW (MA, LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L BRISTOW
Last Name:CAIN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:BRISTOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10310 N 138TH EAST AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4611
Mailing Address - Country:US
Mailing Address - Phone:918-200-9531
Mailing Address - Fax:918-213-2103
Practice Address - Street 1:10310 N 138TH EAST AVE STE 101
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4611
Practice Address - Country:US
Practice Address - Phone:918-200-9531
Practice Address - Fax:918-213-2103
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLPC 4205101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health