Active NPI
Donnie M. Waller, LSW
- Mental Health Counselor
- Chandler, OK
National Provider Identifier
1013020957
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 1775
- Practice address
- 112 McKinley Ave
Chandler, OK 74834-1622 - Phone
- (405) 258-3040
- Fax
- (405) 240-5008
- NPI assigned
- Aug 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 1775 | OK | Primary |
Addresses
Primary practice location
112 McKinley Ave
Chandler, OK 74834-1622
Mailing address
RR 2 Box 220B
Meeker, OK 74855-9305
Phone (405) 214-9667
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1775 | OK | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013020957",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "RR 2 BOX 220B",
"city": "MEEKER",
"state": "OK",
"postal_code": "748559305",
"telephone_number": "405-214-9667"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 MCKINLEY AVE",
"city": "CHANDLER",
"state": "OK",
"postal_code": "748341622",
"telephone_number": "405-258-3040",
"fax_number": "405-240-5008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLER",
"first_name": "DONNIE",
"middle_name": "M.",
"name_prefix": "Mr.",
"credential": "LSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OK",
"license": "1775",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chandler, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.