Active NPI
Kevin Ly
- Professional Counselor
- Oklahoma City, OK
National Provider Identifier
1073394201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- Practice address
- 4400 N Lincoln Blvd
Oklahoma City, OK 73105-5104 - Phone
- (405) 424-7711
- NPI assigned
- Oct 12, 2023
- Sex
- Male
- 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 | OK | Primary |
Addresses
Primary practice location
4400 N Lincoln Blvd
Oklahoma City, OK 73105-5104
Mailing address
1900 NW 176TH St
Edmond, OK 73012-6982
Phone (405) 762-6077
Other practice location 1
6051 N Brookline Ave Ste 112
Oklahoma City, OK 73112-4286
Phone (405) 810-0054
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
4400 N Lincoln Blvd
Oklahoma City, OK 73105-5104
4420 N Lincon Blvd
Red Rock Behavioral
Oklahoma City, OK 73105-5104
Phone (405) 424-7711
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Oklahoma City, OK
- NPI 1275574907
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1697068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711411200000",
"number": "1073394201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 NW 176TH ST",
"city": "EDMOND",
"state": "OK",
"postal_code": "730126982",
"telephone_number": "405-762-6077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4400 N LINCOLN BLVD",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731055104",
"telephone_number": "405-424-7711"
}
],
"practiceLocations": [
{
"address_1": "6051 N Brookline Ave Ste 112",
"address_purpose": "LOCATION",
"city": "Oklahoma City",
"state": "OK",
"postal_code": "731124286",
"country_code": "US",
"telephone_number": "405-810-0054",
"fax_number": "405-810-8977",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LY",
"first_name": "KEVIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-10-12",
"last_updated": "2024-03-26",
"certification_date": "2024-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OK",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"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 Mar 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.