EDISON DALE JEFFUS JR. (NPI# 1407905284) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407905284 |
| Entity Type | Individual |
| Full Name | EDISON DALE JEFFUS JR. |
| Credential | PHD |
| Practice Address |
3220 S Peoria Ave Suite 2 Tulsa OK 74105-2003 |
| Mailing Address |
509 W 33rd St Sand Springs OK 74063-2934 |
| Practice Telephone | 9187495506 |
| Practice Fax Number | 9187495506 |
| Mailing Telephone | 9182411149 |
| Mailing Fax Number | 9187495506 |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2011-12-28 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | 636 | OK | Behavioral Health & Social Service Providers |
| N | 103TC0700X |
Psychologist Specialization: Clinical |
636 | OK | Behavioral Health & Social Service Providers |
| Street Address |
3220 S PEORIA AVE SUITE 2 |
| City | TULSA |
| State | OK |
| Zip Code | 74105-2003 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093082216 | Psychotherapy Solutions of Tulsa LLC | Community/Behavioral Health | 3220 S Peoria Ave, Tulsa, OK 74105-2003 | 2011-11-17 |
| 1528291507 | Mission Physician Services, LLC | General Practice | 3220 S Peoria Ave, Suite 101, Tulsa, OK 74105-2003 | 2009-08-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881208817 | Op Pharmacy LLC | Pharmacy | 2865 E. Skelly Dr., Ste 225, Tulsa, OK 74105 | 2020-09-08 |
| 1114560554 | Secure Interpretation, LLC | Neurological Surgery | 5561 South Lewis Ave, Tulsa, OK 74105 | 2019-10-17 |
| 1629547286 | Kealey Jordan Oliver | Occupational Therapist | 3223 E. 31st Steet, Tulsa, OK 74105 | 2018-11-13 |
| 1265915631 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 3516 S Peoria Ave, Tulsa, OK 74105 | 2018-09-12 |
| 1235635277 | Brenda Kay Sanders | Speech-Language Pathologist | 4911 S Detroit Ave, Tulsa, OK 74105 | 2018-03-30 |
| 1417400771 | Caroline Hunter Heineck | Speech-Language Pathologist | 3223 E. 31st St., Tulsa, OK 74105 | 2016-08-03 |
| 1437509544 | Reliance Care Health Services LLP | Home Health | 5810 S. Peoria Avenue, Tulsa, OK 74105 | 2016-06-20 |
| 1578921748 | Latisha Henderson | Case Manager/Care Coordinator | 3015 E. Skelly Drive, Suite 103, Tulsa, OK 74105 | 2016-02-03 |
| 1326424573 | Evelyn J Fennell | Nurse's Aide | 1143 E 57th Place, Tulsa, OK 74105 | 2015-08-10 |
| 1255717757 | Rebecca Ann Hughes | Dentist | 3150 E 41st St Ste 131, Tulsa, OK 74105 | 2015-08-06 |
| Find all providers in zip 74105 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154837185 | David E Hansen, Ph.d, PC | Clinical Neuropsychologist | 5512 S Lewis Ave Ste 8, Tulsa, OK 74105-7140 | 2017-12-28 |
| 1700177391 | Russell D Pella | Clinical Neuropsychologist | 5213 S Vandalia Ave, Apt. 4g, Tulsa, OK 74135-4038 | 2011-04-29 |
| 1861726663 | Mary Elizabeth Cardoni | Clinical Neuropsychologist | 5110 South Yale Avenue, Suite 103, Tulsa, OK 74135 | 2009-09-25 |
| 1063423994 | Terry Glen Shaw | Clinical Neuropsychologist | 7146 S Braden, Suite 500, Tulsa, OK 74136 | 2006-08-09 |
| 1427062082 | Joseph P Fritsch | Clinical Neuropsychologist | 1717b S Utica Ave, Suite 200, Tulsa, OK 74104-5333 | 2006-07-28 |
| 1457391260 | Roscoe Gordon Burrows II | Clinical Neuropsychologist | 3219 S 79th East Ave, Tulsa, OK 74145-1343 | 2006-06-08 |
| 1457711251 | Neurometrics, Pllc | Clinical Neuropsychologist | 7146 S Braden Ave Ste 500, Tulsa, OK 74136-6376 | 2016-03-07 |
| 1134534787 | Able Kids Therapy | Clinical Neuropsychologist | 5970 E 31st St Ste F, Tulsa, OK 74135-5112 | 2014-06-23 |
| 1699192856 | Clinical & Neuropsychological Services | Clinical Neuropsychologist | 5512 S Lewis Ave, Suite 8, Tulsa, OK 74105-7140 | 2014-03-26 |
| 1295091411 | Brian A. Boatwright, Psy.d., P.l.l.c. | Clinical Neuropsychologist | 5272 S Lewis Ave Ste 250, Tulsa, OK 74105-6564 | 2012-04-02 |
| Find all providers in TULSA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.