Provider Demographics
NPI:1982964649
Name:LEGG-JACK, TUONIMI (BHRS)
Entity Type:Individual
Prefix:MRS
First Name:TUONIMI
Middle Name:
Last Name:LEGG-JACK
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6309 WINFIELD DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-1718
Mailing Address - Country:US
Mailing Address - Phone:405-819-0930
Mailing Address - Fax:
Practice Address - Street 1:6309 WINFIELD DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-1718
Practice Address - Country:US
Practice Address - Phone:405-819-0930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health