Justin Lynn Cicotte

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

405 E Excelsior Ave
Vinita, OK 74301-4226

Phone

(918) 256-6476

Fax

(918) 256-9890

NPI assigned

Jun 20, 2019

Last updated

Nov 24, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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

• Northeastern Oklahoma Council on Alcoholism, Inc.

  • Substance Abuse Rehabilitation Facility
  • Commerce, OK
  • NPI 1336346279
  NPD (past)

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

{
    "created_epoch": "1560988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637712000000",
    "number": "1013577139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 E. EXCELSIOR AVE.",
            "city": "VINITA",
            "state": "OK",
            "postal_code": "74301",
            "telephone_number": "918-265-6476",
            "fax_number": "918-256-9890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 E EXCELSIOR AVE",
            "city": "VINITA",
            "state": "OK",
            "postal_code": "743014226",
            "telephone_number": "918-256-6476",
            "fax_number": "918-256-9890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CICOTTE",
        "first_name": "JUSTIN",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-20",
        "last_updated": "2021-11-24",
        "certification_date": "2021-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "lmatteson@nocacares.onmicrosoft.com",
            "affiliation": "Y",
            "affiliationName": "Northeastern Oklahoma Council on Alcoholism, Inc.",
            "address_1": "130 W Steve Owens Blvd",
            "city": "Miami",
            "state": "OK",
            "country_code": "US",
            "postal_code": "743547629",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "lmatteson@nocacares.onmicrosoft.com",
            "affiliation": "Y",
            "affiliationName": "Northeastern Oklahoma Council on Alcoholism, Inc.",
            "address_1": "130 W Steve Owens Blvd",
            "city": "Miami",
            "state": "OK",
            "country_code": "US",
            "postal_code": "743547629",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Caitlin Brooke Chevalier, OD
• Hayden Chewey
• Deborah Ann Christian, RN
• Shelbee Marie Christie, BACHELOR OF ARTS
• Jackie Ellen Chuculate
• City of Sapulpa (Heartsworth Senior Living)
• Amanda Kay Clark Nieblas
• Joseph C. Clark, D.C.
• Michelle L Clift, DMD
• Steven Ray Coatney

• Peer Specialist in Vinita, OK
• Providers in Vinita, OK by specialty
• Peer Specialist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.