Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 3665 | TN |
NPI | 1063857175 |
---|---|
Provider Name | Dr. Jessica Jaye Capretto |
First Address | Tulsa, OK 74136-1064 |
Second Address | Tulsa, OK 74136-1064 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2013 |
Last Update Date | 13/08/2020 |