Provider Demographics
NPI:1699084079
Name:SIMS, LAVELL ROBERT JR
Entity type:Individual
Prefix:
First Name:LAVELL
Middle Name:ROBERT
Last Name:SIMS
Suffix:JR
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 1:4149 HIGHLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-2103
Mailing Address - Country:US
Mailing Address - Phone:405-949-1000
Mailing Address - Fax:405-949-1063
Practice Address - Street 1:4149 HIGHLINE BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-2103
Practice Address - Country:US
Practice Address - Phone:405-949-1000
Practice Address - Fax:405-949-1063
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health