Modebola Fadare

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

9210 S Western Ave
Ste a-21
Oklahoma City, OK 73139-4982

Phone

(405) 246-9259

Fax

(405) 606-7893

NPI assigned

Mar 27, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

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

{
    "created_epoch": "1364342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463356800000",
    "number": "1063754182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9210 S WESTERN AVE",
            "address_2": "STE A-21",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731394982",
            "telephone_number": "405-246-9259",
            "fax_number": "405-606-7893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9210 S WESTERN AVE",
            "address_2": "STE A-21",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731394982",
            "telephone_number": "405-246-9259",
            "fax_number": "405-606-7893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FADARE",
        "first_name": "MODEBOLA",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-03-27",
        "last_updated": "2016-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OK",
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OK",
            "license": "6107",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Factor
• Crystal Nicole Factor, DSW, MSW, LCSW
• Christiana Factory
• Fred Nolan Factory, M.ED
• Khaldun Jermaine Factory
• Chase Faddis
• Reanna Gabrielle Fadel
• Femi Benjamin Fafunmi, MS, LPC
• Stacy Louise Fagan, P.A.
• Tim R Fagan, DDS, MS

• Mental Health Counselor in Oklahoma City, OK
• Providers in Oklahoma City, 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 May 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.