Provider Demographics
NPI:1801678834
Name:LOUDAKIS, JENNA LYNN
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:LYNN
Last Name:LOUDAKIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 E RIDGECREST RD
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-6901
Mailing Address - Country:US
Mailing Address - Phone:580-471-1674
Mailing Address - Fax:
Practice Address - Street 1:1400 N 11TH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:OK
Practice Address - Zip Code:73542-2035
Practice Address - Country:US
Practice Address - Phone:580-471-1674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor