Healthcare Provider Details

I. General information

NPI: 1639451347
Provider Name (Legal Business Name): JAMES AUSTIN MCVAY JR. B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 CAPITOL DR
EDMOND OK
73003-5073
US

IV. Provider business mailing address

1016 CAPITOL DR
EDMOND OK
73003-5073
US

V. Phone/Fax

Practice location:
  • Phone: 405-923-5347
  • Fax:
Mailing address:
  • Phone: 405-923-5347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: