Provider Demographics
NPI:1134558380
Name:KING, JIMMIE F (PH D)
Entity type:Individual
Prefix:MR
First Name:JIMMIE
Middle Name:F
Last Name:KING
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:MR
Other - First Name:JIMMIE
Other - Middle Name:F
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PH D
Mailing Address - Street 1:3128 WOODSBORO CT
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-3309
Mailing Address - Country:US
Mailing Address - Phone:405-669-3158
Mailing Address - Fax:
Practice Address - Street 1:3128 WOODSBORO CT
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-3309
Practice Address - Country:US
Practice Address - Phone:405-669-3158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1522138101YM0800X
OK171M00000X, 101YP2500X, 106H00000X, 101YA0400X, 101Y00000X
OK104774246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)