Provider Demographics
NPI:1548670102
Name:CAMMON, JEAN LETITIA (MA, LPC)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:LETITIA
Last Name:CAMMON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:J.
Other - Middle Name:LETITIA
Other - Last Name:CAMMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:PO BOX 702504
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74170-2504
Mailing Address - Country:US
Mailing Address - Phone:918-486-9996
Mailing Address - Fax:800-260-7966
Practice Address - Street 1:4122 W 55TH PL
Practice Address - Street 2:SUITE 119
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74107-9108
Practice Address - Country:US
Practice Address - Phone:918-486-9996
Practice Address - Fax:800-260-7966
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4182101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional