Jacob Thomas Crowder

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

7583 Issued in OK

Practice address

21 S Eight Tribes Trail Suite B
Miami, OK 74354-5327

Phone

(918) 387-8720

NPI assigned

Mar 7, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Modoc Nation Behavioral Health

  • Adolescent and Children Mental Health Clinic/Center
  • Miami, OK
  • NPI 1821636358
  NPD (past)

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

{
    "created_epoch": "1488844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642636800000",
    "number": "1104366244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "828 C ST NW",
            "city": "MIAMI",
            "state": "OK",
            "postal_code": "743544613",
            "telephone_number": "918-540-0975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 S EIGHT TRIBES TRAIL SUITE B",
            "city": "MIAMI",
            "state": "OK",
            "postal_code": "743545327",
            "telephone_number": "918-387-8720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROWDER",
        "first_name": "JACOB",
        "middle_name": "THOMAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-07",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OK",
            "license": "7583",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas Sinar Crisp
• Kayla Dawn Crissman, ATC
• Robyn E Crosby
• Dana Clifton Crow
• Kathy Lynn Crow, LPC/LMFT
• Brittany Crowe
• Linda Culp
• Dusty Culver
• Andrea Dawn Cummings, B.S.
• Phillip Andrew Michael Cupples, PHARMD

• Mental Health Counselor in Miami, OK
• Providers in Miami, 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 20, 2022; 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.