Provider Demographics
NPI:1942447719
Name:JAMES, JIMMIE K (MSLPC)
Entity Type:Individual
Prefix:
First Name:JIMMIE
Middle Name:K
Last Name:JAMES
Suffix:
Gender:M
Credentials:MSLPC
Other - Prefix:
Other - First Name:KENNY
Other - Middle Name:
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS,LPC
Mailing Address - Street 1:2105 BERKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74604-2406
Mailing Address - Country:US
Mailing Address - Phone:580-762-7494
Mailing Address - Fax:
Practice Address - Street 1:118 N OAK ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-4238
Practice Address - Country:US
Practice Address - Phone:580-763-7321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1018101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional