Individual
JASON ROBERT MENTING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
550 S PEORIA AVENUE, TULSA, OK 74120-3820
(918) 588-1900
(918) 582-6405
Mailing address
550 S PEORIA AVENUE, TULSA, OK 74120-3820
(918) 588-1900
(918) 582-6405
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1218
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100732910-A
GROUP MEDICAID/SOONERCARE
OK
01
—
100732910-G
GROUP MEDICAID/SOONERCARE
OK
01
—
73-1042545
GROUP MEDICARE
OK
01
—
731042545001
GROUP TRICARE
OK
Enumeration date
08/15/2012
Last updated
01/27/2016
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