Provider Demographics
NPI:1205242377
Name:JONES-SCAMMAHORN, JAMIE (LPC)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:
Last Name:JONES-SCAMMAHORN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:SCAMMAHORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:13340 BIG CEDAR TRL
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-8175
Mailing Address - Country:US
Mailing Address - Phone:405-630-8433
Mailing Address - Fax:
Practice Address - Street 1:105 E ADMIRE AVE
Practice Address - Street 2:
Practice Address - City:KINGFISHER
Practice Address - State:OK
Practice Address - Zip Code:73750-2718
Practice Address - Country:US
Practice Address - Phone:405-630-8433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200547980Medicaid