Provider Demographics
NPI:1669765129
Name:MASSIE, JAMES ANDREW (MS)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ANDREW
Last Name:MASSIE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-1820
Mailing Address - Country:US
Mailing Address - Phone:918-797-7998
Mailing Address - Fax:
Practice Address - Street 1:RR 6 BOX 5
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-9501
Practice Address - Country:US
Practice Address - Phone:918-797-7786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5963101YP2500X
OK101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200362750AMedicaid