Provider Demographics
NPI:1114166899
Name:RIGGINS, JERREL (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JERREL
Middle Name:
Last Name:RIGGINS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:MR
Other - First Name:JERREL
Other - Middle Name:PAUL
Other - Last Name:RIGGINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 1059
Mailing Address - Street 2:
Mailing Address - City:MCLOUD
Mailing Address - State:OK
Mailing Address - Zip Code:74851-1059
Mailing Address - Country:US
Mailing Address - Phone:405-964-2618
Mailing Address - Fax:
Practice Address - Street 1:407 N HIGHWAY 102
Practice Address - Street 2:
Practice Address - City:MCLOUD
Practice Address - State:OK
Practice Address - Zip Code:74851
Practice Address - Country:US
Practice Address - Phone:405-964-2618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK939106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist