Individual
JERRY FENNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12005 E 470 RD, CLAREMORE, OK 74017-3737
(918) 342-0770
(918) 342-0087
Mailing address
114 W DELAWARE AVE, NOWATA, OK 74048-2601
(918) 273-1841
(918) 273-1843
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/18/2010
Last updated
08/18/2010
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