Provider Demographics
NPI:1699985416
Name:POWELL, JANE ELIZABETH (MSW, LADC, LCSW)
Entity type:Individual
Prefix:MISS
First Name:JANE
Middle Name:ELIZABETH
Last Name:POWELL
Suffix:
Gender:F
Credentials:MSW, LADC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53277
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73152-3277
Mailing Address - Country:US
Mailing Address - Phone:405-464-1455
Mailing Address - Fax:405-522-8661
Practice Address - Street 1:3300 N MARTIN LUTHER KING AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-4217
Practice Address - Country:US
Practice Address - Phone:405-464-1455
Practice Address - Fax:405-425-2930
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLADC 705101YA0400X
OK43001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)