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General NPI Number Information
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NPI Number | 1447459482
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Entity Type | Individual
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Provider Name | THOMAS JEFFERSON POUNDERS III LCSW, MDIV, PHD
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Gender | Male
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Dates
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Enumeration Date | 07/11/2007
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Last Update Date | 06/03/2009
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Provider Practice Location Address
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Address Line | 1011 HONOR HEIGHTS DR MAIL CODE 115
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City | MUSKOGEE
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State | OK
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Zip | 74401-1318
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Country | US
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Telephone | 918-577-3000
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Fax | 918-577-3648
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Provider Business Mailing Address
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Address Line | 4421 W OKMULGEE ST # 328
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City | MUSKOGEE
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State | OK
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Zip | 74401-4651
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Country | US
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Telephone | 580-320-5287
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Fax | 918-577-3701
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LCSW 3620
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License Number State | OK
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