Provider Demographics
NPI:1003131277
Name:PROFFER, JOSEPH TROY
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:TROY
Last Name:PROFFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 ROXBORO AVE
Mailing Address - Street 2:APT. 411
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-2543
Mailing Address - Country:US
Mailing Address - Phone:405-822-1374
Mailing Address - Fax:
Practice Address - Street 1:11100 ROXBORO AVE
Practice Address - Street 2:APT. 411
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-2543
Practice Address - Country:US
Practice Address - Phone:405-822-1374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health