Provider Demographics
NPI:1912445305
Name:HAURY, JESSECA MAE
Entity Type:Individual
Prefix:
First Name:JESSECA
Middle Name:MAE
Last Name:HAURY
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 1:6216 S LEWIS AVE
Mailing Address - Street 2:SUITE # 180
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1044
Mailing Address - Country:US
Mailing Address - Phone:918-960-7852
Mailing Address - Fax:
Practice Address - Street 1:6216 S LEWIS AVE
Practice Address - Street 2:SUITE # 180
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1044
Practice Address - Country:US
Practice Address - Phone:918-960-7852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor