Provider Demographics
NPI:1710282900
Name:BOYKINS, JACOLE S
Entity Type:Individual
Prefix:MRS
First Name:JACOLE
Middle Name:S
Last Name:BOYKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11516 N BARNES AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-7720
Mailing Address - Country:US
Mailing Address - Phone:405-753-5438
Mailing Address - Fax:
Practice Address - Street 1:7901 NE 10TH ST
Practice Address - Street 2:SUITE C116
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3600
Practice Address - Country:US
Practice Address - Phone:405-455-7022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health