Individual
LISA DIANNE JEFFCOAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3015 E SKELLY DR, SUITE 103, TULSA, OK 74105-6317
(918) 712-0859
(918) 388-9708
Mailing address
3015 E SKELLY DR, SUITE 103, TULSA, OK 74105-6317
(918) 712-0859
(918) 388-9708
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100746170G
—
OK
05
—
100746170U
—
OK
Enumeration date
08/21/2013
Last updated
08/21/2013
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