Provider Demographics
NPI:1639446669
Name:JAMES, JACQUELINE D (BHRS)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:D
Last Name:JAMES
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 N WACO AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-4936
Mailing Address - Country:US
Mailing Address - Phone:918-584-1717
Mailing Address - Fax:
Practice Address - Street 1:644 N WACO AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-4936
Practice Address - Country:US
Practice Address - Phone:918-584-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200287120Medicaid