Provider Demographics
NPI: | 1568745222 |
---|---|
Name: | HARRINGTON, JIMMY DON (MM BHRS) |
Entity type: | Individual |
Prefix: | MR |
First Name: | JIMMY |
Middle Name: | DON |
Last Name: | HARRINGTON |
Suffix: | |
Gender: | M |
Credentials: | MM BHRS |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2200 SE WASHINGTON BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | BARTLESVILLE |
Mailing Address - State: | OK |
Mailing Address - Zip Code: | 74006-7135 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 918-335-1111 |
Mailing Address - Fax: | 918-335-1119 |
Practice Address - Street 1: | 2200 SE WASHINGTON BLVD |
Practice Address - Street 2: | |
Practice Address - City: | BARTLESVILLE |
Practice Address - State: | OK |
Practice Address - Zip Code: | 74006-7135 |
Practice Address - Country: | US |
Practice Address - Phone: | 918-335-1111 |
Practice Address - Fax: | 918-335-1119 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2011-09-20 |
Last Update Date: | 2011-09-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No | 101YP1600X | Behavioral Health & Social Service Providers | Counselor | Pastoral |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OK | 100732190 | Medicaid |