| Kenny James, M.s., L.p.c., P.c., Ltd. | |
|
118 N Oak St Ponca City OK 74601-4238 | |
| (580) 304-9991 | |
| (580) 762-1066 |
| Full Name | Kenny James, M.s., L.p.c., P.c., Ltd. |
|---|---|
| Speciality | Counselor |
| Location | 118 N Oak St, Ponca City, Oklahoma |
| Authorized Official Name and Position | Jimmie Kenneth James (OWNER) |
| Authorized Official Contact | 5803049991 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenny James, M.s., L.p.c., P.c., Ltd. 118 N Oak St Ponca City OK 74601-4238 Ph: (580) 304-9991 | Kenny James, M.s., L.p.c., P.c., Ltd. 118 N Oak St Ponca City OK 74601-4238 Ph: (580) 304-9991 |
| NPI Number | 1730427725 |
|---|---|
| Provider Enumeration Date | 01/25/2013 |
| Last Update Date | 01/28/2013 |
| Medicare PECOS PAC ID | 7416391081 |
|---|---|
| Medicare Enrollment ID | O20240222001511 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730427725 | NPI | - | NPPES |
| 200231600A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 1018 (Oklahoma) | Primary |
| Provider Name | Jimmie K James |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1942447719 PECOS PAC ID: 3678911948 Enrollment ID: I20240404004422 |
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