Provider Demographics
NPI:1710157136
Name:WIDDIFIELD, JIMMY L JR (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:L
Last Name:WIDDIFIELD
Suffix:JR
Gender:M
Credentials:MA, LPC
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Mailing Address - Street 1:4645 W NICKLAS AVE
Mailing Address - Street 2:APT. B
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-6933
Mailing Address - Country:US
Mailing Address - Phone:405-412-1870
Mailing Address - Fax:
Practice Address - Street 1:940 NE 13TH ST
Practice Address - Street 2:4N 4900
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5008
Practice Address - Country:US
Practice Address - Phone:405-271-8858
Practice Address - Fax:405-271-2931
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2011-10-26
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health