Individual
MR. JIMMY TODD SELF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
32270 E 722 DR, WAGONER, OK 74467-7411
(918) 485-9277
Mailing address
32270 E 722 DR, WAGONER, OK 74467-7411
(918) 485-9277
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3651
OK
Other
Enumeration date
08/17/2006
Last updated
03/30/2009
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