Provider Demographics
NPI:1124507579
Name:JENNINGS, AMY ADELLE (MS, LPC-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ADELLE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MS, LPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 TURKEY KNOB ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-3231
Mailing Address - Country:US
Mailing Address - Phone:405-219-0030
Mailing Address - Fax:
Practice Address - Street 1:1605 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-4022
Practice Address - Country:US
Practice Address - Phone:405-481-7187
Practice Address - Fax:405-481-7219
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional