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General NPI Number Information
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NPI Number | 1952039232
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Entity Type | Individual
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Provider Name | JAMES S BLACK
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Gender | Male
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Dates
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Enumeration Date | 08/12/2022
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 2701 NW 39TH EXPY
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-3775
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Country | US
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Telephone | 405-371-1826
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Fax |
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Provider Business Mailing Address
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Address Line | 9900 W HIGHWAY 66 APT 1005
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City | YUKON
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State | OK
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Zip | 73099-0014
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Country | US
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Telephone | 405-371-1826
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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