JENNIFER RENEA WALLACE (NPI# 1669799086) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669799086 |
| Entity Type | Individual |
| Full Name | JENNIFER RENEA WALLACE |
| Credential | B.A |
| Practice Address |
3802 W University Blvd Apt 8104 Durant OK 74701-3047 |
| Practice Telephone | 5804655961 |
| Mailing Telephone | 5804655961 |
| Enumeration Date | 2010-04-24 |
| Last Update Date | 2010-04-24 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | OK | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356968440 | Jennifer Wallace | Technician/Technologist | 2041 E 3rd Dr, Mesa, AZ 85204-1401 | 2020-07-06 |
| 1497249882 | Jennifer Laird Wallace | Licensed Practical Nurse | 4468 Duff Rd, Livingston, TX 77351-5627 | 2018-06-19 |
| 1124579602 | Jennifer Marie Wallace | Acupuncturist | 237 Avenida Del Norte, Redondo Beach, CA 90277-5702 | 2016-10-19 |
| 1174926984 | Jennifer Wallace | Specialist/Technologist | 806 Patton Chapel Trl, Hoover, AL 35226-2254 | 2014-10-07 |
| 1295083897 | Jennifer Wallace | Psychologist | 4226 Green Lake Rd, West Bloomfield, MI 48323-1139 | 2012-08-29 |
| 1306035431 | Jennifer L Wallace | Physical Therapist | 3891 50th Ave S, Saint Petersburg, FL 33711-4811 | 2007-10-15 |
| 1316974058 | Jennifer Wallace | Speech-Language Pathologist | 1901 Century Blvd Ne Ste 20, Atlanta, GA 30345-3300 | 2006-06-27 |
| 1992766570 | Jennifer P Wallace | Specialist | 64400 E 26th Ct, Byers, CO 80103-8539 | 2006-03-31 |
| 1730154154 | Jennifer Lyn Wallace | Family Medicine | 1235 Se Division St, Suite 208, Portland, OR 97202-1099 | 2006-02-20 |
| 1699760934 | Jennifer L Wallace | Internal Medicine | 7720 Jones Maltsberger, Suite 110, San Antonio, TX 78216 | 2005-09-13 |
| Street Address |
3802 W UNIVERSITY BLVD APT 8104 |
| City | DURANT |
| State | OK |
| Zip Code | 74701-3047 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134738362 | Elevate Therapy, Pllc | Physical Therapist | 523 N Wshington Ave, Durant, OK 74701 | 2020-07-23 |
| 1093334906 | Duncan Kovash | Nurse Practitioner | 1901 Chukka Hina, Durant, OK 74701 | 2020-04-10 |
| 1184193690 | Inventive Therapy Services, LLC | Occupational Therapist | 2620 Maxey Dr, Durant, OK 74701 | 2018-11-14 |
| 1790271831 | Jazmine Gabrielle Benavidez | Specialist/Technologist | 1713 North 1st Avenue, Durant, OK 74701 | 2018-07-02 |
| 1538659586 | Katelen Sue Morgan | Case Manager/Care Coordinator | 1011 Donna Sue Pl, Durant, OK 74701 | 2018-05-15 |
| 1164941035 | Nsight for Life LLC | Community/Behavioral Health | 1313 N 16th, Durant, OK 74701 | 2017-09-12 |
| 1023534666 | Damon Dye | Physical Therapist | 30 W 3rd St, Durant, OK 74701 | 2017-08-15 |
| 1437605250 | Casey Worsham | Nurse Practitioner | 1800 W University, Durant, OK 74701 | 2016-08-31 |
| 1083160857 | Denise Adanho | Case Manager/Care Coordinator | 1218 Stonebrook Circle, Durant, OK 74701 | 2016-08-31 |
| 1962850271 | Justi Thompson | Case Manager/Care Coordinator | 4817 Ciara St, Durant, OK 74701 | 2016-05-26 |
| Find all providers in zip 74701 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407211402 | Kendra Mathis | Counselor | 128 N 12th Ave, Durant, OK 74701-4718 | 2015-12-18 |
| 1144631904 | Jayci Carol Jacks | Counselor | 5419 Roadrunner Dr, Durant, OK 74701-2452 | 2014-05-14 |
| 1740607100 | Woodwater Counseling LLC | Counselor | 1705 N Washington Ave Ste A, Durant, OK 74701-2100 | 2014-03-24 |
| 1982948659 | Craig Andrus | Counselor | 212 W Sycamore St, Durant, OK 74701-4436 | 2012-11-19 |
| 1356695225 | Amanda Beth Johnson | Counselor | 1926 W Elm St, Durant, OK 74701-3430 | 2012-10-31 |
| 1386903235 | Amy D Burnam | Counselor | 4314 W Highway 70, Durant, OK 74701-4588 | 2012-05-14 |
| 1285919134 | Billye Jo Robinson-ellison | Counselor | 3509 Overland Dr, Durant, OK 74701-2294 | 2011-10-11 |
| 1639458300 | June Reanae Childers | Counselor | 142 W. Main St., Durant, OK 74701 | 2011-08-11 |
| 1366761223 | Jill Reese | Counselor | 1105 Lynnwood Street, Durant, OK 74701-2919 | 2010-05-18 |
| 1396877460 | Abbey Rowley | Counselor | 114 S 7th Ave, Durant, OK 74701-5017 | 2007-03-12 |
| Find all providers in DURANT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.