Provider Demographics
NPI:1629195458
Name:NORMAN, JIM D (MED, LPC, HTP)
Entity type:Individual
Prefix:MR
First Name:JIM
Middle Name:D
Last Name:NORMAN
Suffix:
Gender:M
Credentials:MED, LPC, HTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 BELLA SERA DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-2517
Mailing Address - Country:US
Mailing Address - Phone:405-630-8750
Mailing Address - Fax:405-341-1339
Practice Address - Street 1:1941 BELLA SERA DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-2517
Practice Address - Country:US
Practice Address - Phone:405-630-8750
Practice Address - Fax:405-341-1339
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2942101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health