Provider Demographics
NPI:1053598987
Name:ALBANO, JASON ANTHONY (PSYD)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:ANTHONY
Last Name:ALBANO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7603 NW TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-2430
Mailing Address - Country:US
Mailing Address - Phone:417-425-9465
Mailing Address - Fax:
Practice Address - Street 1:7603 NW TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-2430
Practice Address - Country:US
Practice Address - Phone:417-425-9465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006028786101YP2500X
VA0810004447103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional