Provider Demographics
NPI:1811597156
Name:ATKINSON, JEREMY JOSEPH
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:JOSEPH
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 NW 46TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-8226
Mailing Address - Country:US
Mailing Address - Phone:580-243-8515
Mailing Address - Fax:
Practice Address - Street 1:4200 PERIMETER CENTER DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2324
Practice Address - Country:US
Practice Address - Phone:405-795-7526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor