Provider Demographics
NPI:1245522606
Name:MIMS, JEFFREY L JR (BA)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:L
Last Name:MIMS
Suffix:JR
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 TEALWOOD DR
Mailing Address - Street 2:825
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1758
Mailing Address - Country:US
Mailing Address - Phone:405-923-3189
Mailing Address - Fax:
Practice Address - Street 1:2600 TEALWOOD
Practice Address - Street 2:825
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120
Practice Address - Country:US
Practice Address - Phone:405-923-3189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor