Basic Information
| Provider Information | |||||||||
| NPI: | 1588900492 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THORNTON | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | CHERIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 580700 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184300975 | ||||||||
| FaxNumber: | 9184300995 | ||||||||
| Practice Location | |||||||||
| Address1: | 2442 MOHAWK BLVD | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184300975 | ||||||||
| FaxNumber: | 9184300995 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2012 | ||||||||
| LastUpdateDate: | 06/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.