MEDICARE: MS. KIM DENISE JAMES LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	2962	OK

General Provider Information

NPI Number	:	1700963774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIM DENISE JAMES LPC

Provider Business Mailing Address
First Line	:	3100 MEDICAL PKWY
Second Line	:
City	:	CLAREMORE
State	:	OK
Zip	:	74017-1088
Country	:	US
Telephone Number	:	918-342-0770
Fax Number	:	918-342-0087

Provider Business Practice Location Address
First Line	:	3100 MEDICAL PKWY
Second Line	:
City	:	CLAREMORE
State	:	OK
Zip	:	74017-1088
Country	:	US
Telephone Number	:	918-342-0770
Fax Number	:	918-342-0087

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/01/2022

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