Provider Demographics
NPI:1023580990
Name:SIKES, JEFFERY GALE
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:GALE
Last Name:SIKES
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:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:ALLEENE
Mailing Address - State:AR
Mailing Address - Zip Code:71820-0058
Mailing Address - Country:US
Mailing Address - Phone:501-351-5606
Mailing Address - Fax:
Practice Address - Street 1:321 E 13TH ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:AR
Practice Address - Zip Code:71958-9541
Practice Address - Country:US
Practice Address - Phone:870-230-8217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2006086101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health