=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336632264
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES ANTHONY KAISER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2018
-----------------------------------------------------
Last Update Date | 06/14/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 712 DEVON ST
-----------------------------------------------------
City | STILLWATER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74074-1926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-372-6100
-----------------------------------------------------
Fax | 405-624-7516
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 712 DEVON ST
-----------------------------------------------------
City | STILLWATER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74074-1926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 53-726-1004
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------