Provider Demographics
NPI:1720336142
Name:MENTING, JASON ROBERT (PSYD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ROBERT
Last Name:MENTING
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 S PEORIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-3820
Mailing Address - Country:US
Mailing Address - Phone:918-588-1900
Mailing Address - Fax:918-582-6405
Practice Address - Street 1:550 S PEORIA AVENUE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-3820
Practice Address - Country:US
Practice Address - Phone:918-588-1900
Practice Address - Fax:918-582-6405
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK1218103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK73-1042545OtherGROUP MEDICARE
OK73-1042545OtherGROUP BCBS
OK731042545001OtherGROUP TRICARE
OK100732910-GOtherGROUP MEDICAID/SOONERCARE
OK73-1042545OtherGROUP COMMUNITY CARE OF OKLAHOMA
OK100732910-AOtherGROUP MEDICAID/SOONERCARE
OK731042545001OtherGROUP TRICARE