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Complete NPI Record 1649593492
Counselor - Professional in Oklahoma City, OK

NPI Status: Active since March 09, 2010

Contact Information

3240 W BRITTON RD STE 102
OKLAHOMA CITY, OK
ZIP 73120
Phone: (405) 413-2527
Fax: (405) 418-0177

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Complete NPI Dataset

This page represents the complete record for NPI 1649593492. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1649593492
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 3604 SAGE TRAIL CIR
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: OKLAHOMA CITY
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: OK
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 731794819
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 4054132527
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 4054180177
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 3240 W BRITTON RD STE 102
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: OKLAHOMA CITY
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: OK
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 731202040
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 4054132527
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 4054180177
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 3/9/2010
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 3/9/2010
The date that a record was last updated or changed.
Authorized Official Last Name: REYNOLDS
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: VICKI
The first name of the authorized official.
Authorized Official Middle Name: S.
The middle name of the authorized official.
Authorized Official Title or Position: OWNER
The title or position of the authorized official.
Authorized Official Telephone Number: 4054132527
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 101YP2500X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Organization Subpart: N
Authorized Official Name Prefix Text: MRS.
Authorized Official Credential Text: M.S., LPC-LMFT
Healthcare Provider Taxonomy Group 1: 193400000X SINGLE SPECIALTY GROUP