Organization
SECOND WIND RECOVERY AND SUPPORT SERVICES PLLC
Active
Organization
SECOND WIND RECOVERY AND SUPPORT SERVICES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JACQUELYN D. JORDAN MA, LADC (CEO/OWNER)
(405) 605-0881
Entity
Organization
Contact information
Practice address
3700 N CLASSEN BLVD, SUITE C-55, OKLAHOMA CITY, OK 73118-2872
(405) 605-0881
(405) 605-0879
Mailing address
3700 N CLASSEN BLVD, SUITE C-55, OKLAHOMA CITY, OK 73118-2872
(405) 605-0881
(405) 605-0879
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
490
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114263001
NPI
OK
05
—
200530290A
—
OK
Enumeration date
04/24/2014
Last updated
04/24/2014
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