Provider Demographics
NPI:1104249150
Name:BOINTY, JANESSA LADAWN (MED, LPC CANDIDATE)
Entity type:Individual
Prefix:
First Name:JANESSA
Middle Name:LADAWN
Last Name:BOINTY
Suffix:
Gender:F
Credentials:MED, LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14117 N ROCKWELL AVE APT 6205
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-8034
Mailing Address - Country:US
Mailing Address - Phone:405-209-5571
Mailing Address - Fax:
Practice Address - Street 1:5359 S. WESTERN AVE. #707
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109
Practice Address - Country:US
Practice Address - Phone:405-474-5359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor