Provider Demographics
NPI:1831418375
Name:KODESH, JENA G
Entity type:Individual
Prefix:MRS
First Name:JENA
Middle Name:G
Last Name:KODESH
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 1:4801 COUNTY ROAD 110
Mailing Address - Street 2:
Mailing Address - City:RED ROCK
Mailing Address - State:OK
Mailing Address - Zip Code:74651-0322
Mailing Address - Country:US
Mailing Address - Phone:580-761-5726
Mailing Address - Fax:
Practice Address - Street 1:4801 COUNTY ROAD 110
Practice Address - Street 2:
Practice Address - City:RED ROCK
Practice Address - State:OK
Practice Address - Zip Code:74651-0322
Practice Address - Country:US
Practice Address - Phone:580-761-5726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor