Provider Demographics
NPI:1306326483
Name:MUNGAI, JAMIE LYNN (LPC-S)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:MUNGAI
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 W HARRISON AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-4737
Mailing Address - Country:US
Mailing Address - Phone:405-426-9080
Mailing Address - Fax:
Practice Address - Street 1:114 W HARRISON AVE STE 103
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-4737
Practice Address - Country:US
Practice Address - Phone:405-426-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200789570AMedicaid