Provider Demographics
NPI:1952944803
Name:WORSTELL WOHLETZ, JAMIE (LPC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:WORSTELL WOHLETZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:WORSTELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1912 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74604-4800
Mailing Address - Country:US
Mailing Address - Phone:580-763-1902
Mailing Address - Fax:
Practice Address - Street 1:1912 LAKE RD
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74604-4800
Practice Address - Country:US
Practice Address - Phone:580-763-1902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10760101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional