Individual
TRACEY MIDDLETON JENNINGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW, LADC
Contact information
Practice address
8937 S GARNETT RD, BROKEN ARROW, OK 74012-6004
(918) 872-9777
(918) 872-9779
Mailing address
2990 N SIOUX AVE, CLAREMORE, OK 74017-3700
(918) 342-2622
(918) 342-2641
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1033
OK
1041C0700X
Clinical Social Worker
3963
OK
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3963
LICENSE
OK
Enumeration date
05/12/2010
Last updated
07/12/2016
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