Individual provider Active NPI

Tiffany Sharrice Harrison, LCSW LADC/MH

  • Clinical Social Worker
  • Oklahoma City, OK
National Provider Identifier
1104174556
Registry record updated Dec 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
8814 Issued in OK
Practice address
921 NE 13TH St
Oklahoma City, OK 73104-5007
Phone
(405) 456-1000
NPI assigned
Aug 16, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 1423 OK
Social Worker 104100000X 6514 OK
Clinical Social Worker 1041C0700X 8814 OK Primary

Addresses

Primary practice location

921 NE 13TH St
Oklahoma City, OK 73104-5007

Mailing address

2000 Eastridge PL
Oklahoma City, OK 73141-2226
Phone (405) 625-0710

Other practice location 1

2000 Eastridge Pl
Oklahoma City, OK 73141-2226
Phone (405) 625-0710

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
I20221206000868 OK Practitioner - Clinical Social Worker 5799154225 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5509 Main St
Suite 103
Del City, OK 73115-5511
Phone (405) 627-9308

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6514OKMDProfessional Counselor
8814OKMDSpecialist
1423OKMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Intentional Paths to Recovery, LLC Clinical CurrentSince Sep 23, 2022 Accepting new patients
Behavioral Wellness and Care Team of Ok LLC CurrentSince Mar 31, 2024 Accepting new patients
Clarissa M Wright LPC PLLC PastSince Aug 1, 2024 Accepting new patients

Locations

5509 Main St
Ste 103
Del City, OK 73115
Phone (405) 627-9308

1212 S Air Depot Blvd
Ste 19B
Midwest City, OK 73110
Phone (405) 455-7244

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1345075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733443200000",
    "number": "1104174556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 EASTRIDGE PL",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731412226",
            "telephone_number": "405-625-0710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 NE 13TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045007",
            "telephone_number": "405-456-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2000 Eastridge Pl",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731412226",
            "country_code": "US",
            "telephone_number": "405-625-0710",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARRISON",
        "first_name": "TIFFANY",
        "middle_name": "SHARRICE",
        "name_prefix": "Mrs.",
        "credential": "LCSW LADC/MH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-16",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OK",
            "license": "1423",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OK",
            "license": "6514",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OK",
            "license": "8814",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.