1003174608 NPI number — JANICE L. HENDRYX

Table of content: (NPI 1003174608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003174608 NPI number — JANICE L. HENDRYX

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JANICE L. HENDRYX
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003174608
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7244 NW 129TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73142-2544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-517-7612
Provider Business Mailing Address Fax Number:
405-603-6624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3908 N PENIEL AVE
Provider Second Line Business Practice Location Address:
SUITE 420
Provider Business Practice Location Address City Name:
BETHANY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73008-3458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-603-3265
Provider Business Practice Location Address Fax Number:
405-603-6624
Provider Enumeration Date:
05/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HENDRYX
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
LICENSED CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
405-517-7612

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  4205 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200362380B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com