Provider Demographics
NPI:1134592058
Name:OZIO, JAMES STEPHEN (LBP)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:STEPHEN
Last Name:OZIO
Suffix:
Gender:M
Credentials:LBP
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:STEPHEN
Other - Last Name:OZIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LBP
Mailing Address - Street 1:5202 W GORE BLVD
Mailing Address - Street 2:5202 W. GORE BOULEVARD
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5840
Mailing Address - Country:US
Mailing Address - Phone:580-355-9144
Mailing Address - Fax:580-585-6329
Practice Address - Street 1:5202 W GORE BLVD
Practice Address - Street 2:5202 W. GORE BOULEVARD
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5840
Practice Address - Country:US
Practice Address - Phone:580-355-9144
Practice Address - Fax:580-585-6329
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0012101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK000000Medicaid
OK1265493837Medicaid