Active NPI
Tara Matlock, LPC
- Professional Counselor
- Oklahoma City, OK
National Provider Identifier
1023769130
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 10454
- Practice address
- 13929 Technology Dr
Oklahoma City, OK 73134-1053 - Phone
- (405) 496-1511
- NPI assigned
- Jan 11, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 10454 | OK | Primary |
Addresses
Primary practice location
13929 Technology Dr
Oklahoma City, OK 73134-1053
Mailing address
13929 Technology Dr Ste a
Oklahoma City, OK 73134-1053
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | matlocktara.70@gmail.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 5, 2026 through Mar 5, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10454 | OK | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1641859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641859200000",
"number": "1023769130",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13929 TECHNOLOGY DR STE A",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731341053"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13929 TECHNOLOGY DR",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731341053",
"telephone_number": "405-496-1511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATLOCK",
"first_name": "TARA",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-01-11",
"last_updated": "2022-01-11",
"certification_date": "2022-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OK",
"license": "10454",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "matlocktara.70@gmail.com",
"affiliation": "N",
"endpointDescription": "work email",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "correspondence",
"address_1": "13929 Technology Dr",
"city": "Oklahoma City",
"state": "OK",
"country_code": "US",
"postal_code": "731341053",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.