Provider Demographics
NPI:1588940480
Name:CHAFIN, JENNIFER M
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:CHAFIN
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 1:1516 S BOSTON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-4003
Mailing Address - Country:US
Mailing Address - Phone:918-561-6000
Mailing Address - Fax:
Practice Address - Street 1:1516 S BOSTON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-4003
Practice Address - Country:US
Practice Address - Phone:918-561-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK47641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical