Provider Demographics
NPI:1962835892
Name:MAXWELL, JEREMIAH BILYEU
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:BILYEU
Last Name:MAXWELL
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 1:106 WAPITI
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-8404
Mailing Address - Country:US
Mailing Address - Phone:918-704-2663
Mailing Address - Fax:
Practice Address - Street 1:106 WAPITI
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-8404
Practice Address - Country:US
Practice Address - Phone:918-704-2663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor