Provider Demographics
NPI:1801222096
Name:TRIMMER, JASON LEE (BHRS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:LEE
Last Name:TRIMMER
Suffix:
Gender:M
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14126 COUNTY ROAD 1573
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-1552
Mailing Address - Country:US
Mailing Address - Phone:580-399-4803
Mailing Address - Fax:
Practice Address - Street 1:14126 COUNTY ROAD 1573
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-1552
Practice Address - Country:US
Practice Address - Phone:580-399-4803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator