Provider Demographics
NPI:1912531252
Name:JEFFERSON, LORI (MSED)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-6818
Mailing Address - Country:US
Mailing Address - Phone:918-348-6461
Mailing Address - Fax:
Practice Address - Street 1:207 S 11TH ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-6818
Practice Address - Country:US
Practice Address - Phone:918-348-6461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor