Individual
JACQUE S KOMERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6501 N BROADWAY EXT SUITE 180, OKLAHOMA CITY, OK 73116
(405) 607-4041
Mailing address
25518 N 2850 RD, KINGFISHER, OK 73750
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YS0200X
School Counselor
—
—
103K00000X
Behavior Analyst
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
Other
Enumeration date
09/04/2017
Last updated
09/04/2017
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