Provider Demographics
NPI:1558824219
Name:LOUGHRIDGE, JONI R
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:R
Last Name:LOUGHRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JONI
Other - Middle Name:R
Other - Last Name:CLAYCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1247
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-1247
Mailing Address - Country:US
Mailing Address - Phone:580-338-5851
Mailing Address - Fax:580-338-6022
Practice Address - Street 1:1521 HWY 54 N
Practice Address - Street 2:1521 HWY 54 N
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942
Practice Address - Country:US
Practice Address - Phone:580-338-5851
Practice Address - Fax:580-338-6022
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician