Individual
JANELLE MAILLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
921 NE 13TH ST, OKLAHOMA CITY, OK 73104-5007
(405) 249-3149
Mailing address
3517 NW 69TH ST, OKLAHOMA CITY, OK 73116-2126
(405) 249-3149
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
5369
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
R080388927
—
OK
Enumeration date
08/06/2010
Last updated
11/25/2024
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