Provider Demographics
NPI:1487985271
Name:GRUENBERG, JORDAN
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:GRUENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E ELDER LN
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-4617
Mailing Address - Country:US
Mailing Address - Phone:405-596-0178
Mailing Address - Fax:405-701-5843
Practice Address - Street 1:116 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-1307
Practice Address - Country:US
Practice Address - Phone:405-919-6821
Practice Address - Fax:405-701-5843
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health