Progressive Healing Therapeutic Practice, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

5616 Issued in OK

Legal business name

PROGRESSIVE HEALING THERAPEUTIC PRACTICE, LLC

Practice address

701 W 101St PL S
818
Jenks, OK 74037-3505

Phone

(918) 504-5909

NPI assigned

Jan 6, 2015

Organization subpart

No

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

Authorized official

Name

Nicole Menyon Roberson, MHR

Title

Owner/Licensed Professional

Phone

(918) 504-5909

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1420502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420502400000",
    "number": "1043608508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 W 101ST PL S",
            "address_2": "818",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740373505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 W 101ST PL S",
            "address_2": "818",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740373505",
            "telephone_number": "918-504-5909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE HEALING THERAPEUTIC PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-06",
        "last_updated": "2015-01-06",
        "status": "A",
        "authorized_official_last_name": "ROBERSON",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "MENYON",
        "authorized_official_title_or_position": "OWNER/LICENSED PROFESSIONAL",
        "authorized_official_telephone_number": "918-504-5909",
        "authorized_official_credential": "MHR"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "OK",
            "license": "5616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Jenks, OK
• Providers in Jenks, OK by specialty
• Mental Health Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2015; 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.