Provider Demographics
NPI:1285331504
Name:ANDERSON, JAMIE LYNN
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 REYNOLDS AVE
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-4724
Mailing Address - Country:US
Mailing Address - Phone:918-649-0172
Mailing Address - Fax:918-649-0316
Practice Address - Street 1:1212 REYNOLDS AVE
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4724
Practice Address - Country:US
Practice Address - Phone:918-649-0172
Practice Address - Fax:918-649-0316
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor