| Queen Dejear Llc | |
|
1330 N Classen Blvd Ste 125 Oklahoma City OK 73106-6834 | |
| (405) 923-1125 | |
| Not Available |
| Full Name | Queen Dejear Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1330 N Classen Blvd Ste 125, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Terrance T Jones (CEO/CLINICAL DIRECTOR) |
| Authorized Official Contact | 4059231125 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Queen Dejear Llc 1330 N Classen Blvd Ste 125 Oklahoma City OK 73106-6834 Ph: (405) 923-1125 | Queen Dejear Llc 1330 N Classen Blvd Ste 125 Oklahoma City OK 73106-6834 Ph: (405) 923-1125 |
| NPI Number | 1194585729 |
|---|---|
| Provider Enumeration Date | 03/20/2024 |
| Last Update Date | 04/02/2024 |
| Certification Date | 04/02/2024 |
| Medicare PECOS PAC ID | 4688013915 |
|---|---|
| Medicare Enrollment ID | O20240418002682 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194585729 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Terrance Tyrell Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255892956 PECOS PAC ID: 3274910138 Enrollment ID: I20220513001798 |
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