Provider Demographics
NPI:1205908886
Name:FINE-THOMAS, JEFFREY ALAN (MA)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALAN
Last Name:FINE-THOMAS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 NW 139TH STREET PKWY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-9525
Mailing Address - Country:US
Mailing Address - Phone:405-323-0923
Mailing Address - Fax:
Practice Address - Street 1:916 NW 139TH STREET PKWY
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-9525
Practice Address - Country:US
Practice Address - Phone:405-323-0923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK750106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist