Provider Demographics
NPI:1619229424
Name:JAMES, CANDICE (BS, BHRS)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:BS, BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 DEWEY AVE
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-4224
Mailing Address - Country:US
Mailing Address - Phone:918-649-0909
Mailing Address - Fax:
Practice Address - Street 1:205 DEWEY AVE
Practice Address - Street 2:SUITE # 2
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4224
Practice Address - Country:US
Practice Address - Phone:918-649-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100746580-FMedicaid