Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 7802 | OK |
NPI | 1003208919 |
---|---|
Provider Name | Mr. James Perry |
First Address | Yukon, OK 73099-1723 |
Second Address | Oklahoma City, OK 73142-4437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2015 |
Last Update Date | 01/12/2021 |