Provider Demographics
NPI:1215288691
Name:RUCKER, JASON LEMONTE
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:LEMONTE
Last Name:RUCKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 CAROL ANN PL
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2383
Mailing Address - Country:US
Mailing Address - Phone:405-501-8424
Mailing Address - Fax:
Practice Address - Street 1:712 CAROL ANN PL
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2383
Practice Address - Country:US
Practice Address - Phone:405-501-8424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst