Provider Demographics
NPI:1528390317
Name:JAMES, WANDA YVONNE (MSP)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:YVONNE
Last Name:JAMES
Suffix:
Gender:F
Credentials:MSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8513 CANDLEWOOD DR APT 168
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-4422
Mailing Address - Country:US
Mailing Address - Phone:405-722-8951
Mailing Address - Fax:
Practice Address - Street 1:8513 CANDLEWOOD DR APT 168
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-4422
Practice Address - Country:US
Practice Address - Phone:405-722-8951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)