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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