Provider Demographics
NPI:1063991727
Name:OGG, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:OGG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 S OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:OK
Mailing Address - Zip Code:73728-2545
Mailing Address - Country:US
Mailing Address - Phone:580-596-2800
Mailing Address - Fax:580-596-2805
Practice Address - Street 1:231 S 30TH ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-6455
Practice Address - Country:US
Practice Address - Phone:580-596-2800
Practice Address - Fax:580-596-2805
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7730101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK101Y00000XMedicaid