| Doctor Name: | JEREMY CLINT HONNOLL |
| NPI Number: | 1235338617 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 200 N Choctaw Ave El Reno, OK - 730362624 |
| Business Phone Number: | 4052623209 |
| Business Fax Number: | |
| Mailing Address: | 300 N Pebble Creek Ter Apt 203, MUSTANG |
| State: | OK |
| Postal Code: | 730644174 |
| Phone Number: | 4055508736 |
| Fax Number: | |
| NPI Enumeration Date: | 07/16/2007 |
| NPI Last Update Date: | 09/24/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |