Provider Demographics
NPI:1417181231
Name:MANN, JAMES DAVID JR
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DAVID
Last Name:MANN
Suffix:JR
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 1:9022 S DARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-3567
Mailing Address - Country:US
Mailing Address - Phone:619-459-7718
Mailing Address - Fax:
Practice Address - Street 1:5569 S LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-7132
Practice Address - Country:US
Practice Address - Phone:918-742-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist