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2617 General Pershing Blvd Oklahoma City OK 73107-6437 | |
| (405) 858-1700 | |
| (405) 858-2810 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 2617 General Pershing Blvd, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Lonnie Rice (CFO) |
| Authorized Official Contact | 4058582735 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 12978 Oklahoma City OK 73157-2978 Ph: (405) 858-2700 | 2617 General Pershing Blvd Oklahoma City OK 73107-6437 Ph: (405) 858-1700 |
| NPI Number | 1821120189 |
|---|---|
| Provider Enumeration Date | 03/12/2007 |
| Last Update Date | 04/15/2024 |
| Certification Date | 04/15/2024 |
| Medicare PECOS PAC ID | 6002701786 |
|---|---|
| Medicare Enrollment ID | O20040220000470 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821120189 | NPI | - | NPPES |
| 100735340F | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Rajeswara Bhupathiraju |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578599916 PECOS PAC ID: 8628966793 Enrollment ID: I20040310001011 |
| Provider Name | Sue C Rollins |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1528104684 PECOS PAC ID: 1254418080 Enrollment ID: I20080404000001 |
| Provider Name | Ahsan Y Khan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346245479 PECOS PAC ID: 4082640354 Enrollment ID: I20111102000303 |
| Provider Name | Agata K Karch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952555344 PECOS PAC ID: 8628228491 Enrollment ID: I20121101000585 |
| Provider Name | Sandra Taber |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184766511 PECOS PAC ID: 6002043940 Enrollment ID: I20131220000606 |
| Provider Name | Brandie A Strange |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699102616 PECOS PAC ID: 2769612647 Enrollment ID: I20141027001210 |
| Provider Name | Rachel J Picon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346557865 PECOS PAC ID: 3870819584 Enrollment ID: I20150223001793 |
| Provider Name | Josephine Deguzman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043391675 PECOS PAC ID: 0143509455 Enrollment ID: I20161109000882 |
| Provider Name | Peter Craig Kowalski |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639107444 PECOS PAC ID: 4880839208 Enrollment ID: I20180928001550 |
| Provider Name | Sophia Renee Nieto |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659710325 PECOS PAC ID: 4981945458 Enrollment ID: I20190410000864 |
| Provider Name | Darlene Rose Cook |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548479025 PECOS PAC ID: 0446591820 Enrollment ID: I20190411002815 |
| Provider Name | Kathryn Marie Shelton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164996641 PECOS PAC ID: 0840531901 Enrollment ID: I20190418000670 |
| Provider Name | Mary Margaret Mcmiller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194108746 PECOS PAC ID: 9133457849 Enrollment ID: I20190820000392 |
| Provider Name | Kelsey Ann Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033619465 PECOS PAC ID: 5698160372 Enrollment ID: I20220315002868 |
| Provider Name | Jessica Anne Stevens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356846133 PECOS PAC ID: 8123473568 Enrollment ID: I20231004003991 |
| Provider Name | Margaret Call |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1124794516 PECOS PAC ID: 9133571722 Enrollment ID: I20240119000126 |
| Provider Name | Tara Linden Gamsjager |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1205054707 PECOS PAC ID: 1052754827 Enrollment ID: I20240208002027 |
| Provider Name | Jeffery David Bishop |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275171076 PECOS PAC ID: 8921441619 Enrollment ID: I20240209001418 |
| Provider Name | Garrett Thomas Gilmore |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326624453 PECOS PAC ID: 3870937998 Enrollment ID: I20240216002403 |
| Provider Name | Vanessa Fortune |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225417165 PECOS PAC ID: 1557706827 Enrollment ID: I20240226003573 |
| Provider Name | Lacinda Shae Daugherty |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1366646523 PECOS PAC ID: 9537504543 Enrollment ID: I20240229002827 |
| Provider Name | Robin Lee Moore |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1881803526 PECOS PAC ID: 3870930019 Enrollment ID: I20240322002390 |
| Provider Name | Christopher Gordon Geis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497209886 PECOS PAC ID: 3072951714 Enrollment ID: I20240401002423 |
| Provider Name | Karli Nicole Mcfarland |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1801402334 PECOS PAC ID: 2961840483 Enrollment ID: I20240403002216 |
| Provider Name | Stephanie Carey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588096564 PECOS PAC ID: 4082053137 Enrollment ID: I20240422002836 |
| Provider Name | Corie King |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184384968 PECOS PAC ID: 7214472703 Enrollment ID: I20240709001648 |
| Provider Name | Mckenzie Merenick |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1629647557 PECOS PAC ID: 1153867668 Enrollment ID: I20240720000330 |
| Provider Name | Megan Rachelle Wadsack |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003408618 PECOS PAC ID: 0547706004 Enrollment ID: I20240722001247 |
| Provider Name | Rachel Austin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740698976 PECOS PAC ID: 3971049180 Enrollment ID: I20240724002486 |
| Provider Name | Jessica Anne Meyers |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1245689314 PECOS PAC ID: 3072059088 Enrollment ID: I20240726000749 |
| Provider Name | Courtney Brooke See Elizondo |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1255632626 PECOS PAC ID: 6709325418 Enrollment ID: I20240826004248 |
| Provider Name | John Michael Cloud |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003568692 PECOS PAC ID: 0143760223 Enrollment ID: I20240904004339 |
| Provider Name | Emily Bernhard |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740931310 PECOS PAC ID: 5395285399 Enrollment ID: I20240905000696 |
| Provider Name | Lloyd Wilson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720677206 PECOS PAC ID: 8123559176 Enrollment ID: I20241002001015 |
| Provider Name | Sierra Gilbert |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1760074553 PECOS PAC ID: 7719418763 Enrollment ID: I20241002001193 |
| Provider Name | Sidney Stover |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1881360360 PECOS PAC ID: 0840722120 Enrollment ID: I20241010003731 |
| Provider Name | Maryalice Ruth Case |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982310611 PECOS PAC ID: 1355873555 Enrollment ID: I20241013000168 |
Innovative Community Resource Specialist Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3535 Nw 58th St Ste 870e, Oklahoma City, OK 73112 Phone: 405-205-8346 | |
Nami Oklahoma, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1920 N Drexel Blvd, Oklahoma City, OK 73107 Phone: 405-230-1900 Fax: 405-230-1903 | |
Gabriel M Pitman Do Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 401 Sw 80th St, Suite 201, Oklahoma City, OK 73109 Phone: 405-632-9090 Fax: 405-632-9097 | |
Quality Counseling & Intervention Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1330 N Classen Blvd, Suite 311, Oklahoma City, OK 73106 Phone: 405-702-0502 Fax: 405-702-0502 | |
Building Up People Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2525 Nw Expressway, 531, Oklahoma City, OK 73112 Phone: 405-242-5031 | |