Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1689934549 |
---|---|
Provider Name | Mr. Trent Stacey Jones |
First Address | Oklahoma City, OK 73107-2645 |
Second Address | Oklahoma City, OK 73107-2645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2012 |
Last Update Date | 24/05/2012 |