Provider Demographics
NPI:1730427725
Name:KENNY JAMES, M.S., L.P.C., P.C., LTD.
Entity type:Organization
Organization Name:KENNY JAMES, M.S., L.P.C., P.C., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIMMIE
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:580-304-9991
Mailing Address - Street 1:118 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-4238
Mailing Address - Country:US
Mailing Address - Phone:580-304-9991
Mailing Address - Fax:580-762-1066
Practice Address - Street 1:118 N OAK ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-4238
Practice Address - Country:US
Practice Address - Phone:580-304-9991
Practice Address - Fax:580-762-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-25
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1018101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200231600AMedicaid