Individual provider Active NPI

Jessica Enchana Richard, LPC

  • Mental Health Counselor
  • Stillwater, OK
National Provider Identifier
1043330988
Registry record updated Nov 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
6728 Issued in OK
Practice address
604 S Walnut St
Stillwater, OK 74074-4222
Phone
(405) 372-2202
Fax
(405) 445-3780
NPI assigned
Mar 31, 2007
Last updated
Nov 25, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2019

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 6728 OK Primary

Addresses

Primary practice location

604 S Walnut St
Stillwater, OK 74074-4222

Mailing address

604 S Walnut St
Stillwater, OK 74074-4222
Phone (405) 372-2202

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
I20231207003447 OK Practitioner - Mental Health Counselor 1254780869 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

604 S Walnut St
Stillwater, OK 74074-4222
Phone (405) 372-2202

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6728OKMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Grand Lake Mental Health Center, Inc. CurrentSince Jan 1, 2024 Accepting new patients
Grand Lake Mental Health Center, Inc. Current Accepting new patients
Grand Lake Mental Health Center Inc. CurrentSince Jan 1, 2024 Accepting new patients

Locations

111 S Treaty Rd
Miami, OK 74354
Phone (918) 540-1511

114 W Delaware Ave
Nowata, OK 74048
Phone 91827318412207

1624 Cimarron Plz
Stillwater, OK 74075
Phone (800) 722-3611

604 S Walnut St
Stillwater, OK 74074
Phone (405) 338-7072

998 E Knotts Ave
Stillwater, OK 74075
Phone (539) 240-0907

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1175299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574640000000",
    "number": "1043330988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 S WALNUT ST",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740744222",
            "telephone_number": "405-372-2202",
            "fax_number": "405-445-3780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 S WALNUT ST",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740744222",
            "telephone_number": "405-372-2202",
            "fax_number": "405-445-3780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARD",
        "first_name": "JESSICA",
        "middle_name": "ENCHANA",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-31",
        "last_updated": "2019-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OK",
            "license": "6728",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stillwater, OK

Sources for this page

Verify at the official NPI Registry.