Provider Demographics
NPI:1770073389
Name:JARVIS, ALICIA MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:JARVIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14204 LITTLE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73078-7849
Mailing Address - Country:US
Mailing Address - Phone:405-226-4276
Mailing Address - Fax:
Practice Address - Street 1:14204 LITTLE BROOK DR
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:OK
Practice Address - Zip Code:73078-7849
Practice Address - Country:US
Practice Address - Phone:405-226-4276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10574106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist