Individual provider Active NPI

Candace Brown

  • Mental Health Counselor
  • Ardmore, OK
National Provider Identifier
1013401868
Registry record updated Jan 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
2530 S Commerce St BLDG B
Ardmore, OK 73401-5519
Phone
(802) 235-6365
Fax
(580) 226-6727
NPI assigned
Jun 15, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

2530 S Commerce St BLDG B
Ardmore, OK 73401-5519

Mailing address

PO Box 189
Ardmore, OK 73402-0189
Phone (580) 223-5636

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260602001671 OK Practitioner - Mental Health Counselor 9638665326 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lighthouse Behavioral Wellness CentersGroup PAC ID 6406748961, 59 clinicians

Practice addresses (Care Compare)

2530 S Commerce St
BLDG B
Ardmore, OK 73401-5519
Phone (580) 223-5636

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1529020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705449600000",
    "number": "1013401868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 189",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734020189",
            "telephone_number": "580-223-5636",
            "fax_number": "580-226-6727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 S COMMERCE ST BLDG B",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734015519",
            "telephone_number": "802-235-6365",
            "fax_number": "580-226-6727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "CANDACE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-15",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ardmore, OK

Sources for this page

Verify at the official NPI Registry.