Jeanne Devo Black, M.ED., LPC, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

1022 Issued in OK

Practice address

4400 N Lincoln Blvd
Oklahoma City, OK 73105-5108

Phone

(405) 424-7711

NPI assigned

May 12, 2010

Last updated

Oct 22, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Jeanne Devo Fair Former name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Education

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Oklahoma Mental Health Council

  dba Red Rock Behavioral Health Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Oklahoma City, OK
  • NPI 1275574907
  Medicare reassignment NPD
• Oklahoma Mental Health Council

  dba Red Rock Behavioral Health Services

  • Community/Behavioral Health Agency
  • Hobart, OK
  • NPI 1801219340
  NPD

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

{
    "created_epoch": "1273622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571702400000",
    "number": "1114245305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 N LINCOLN BLVD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731055108",
            "telephone_number": "405-424-7711"
        },
        {
            "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": "731055108",
            "telephone_number": "405-424-7711"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 W I 240 Service Rd",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731397701",
            "country_code": "US",
            "telephone_number": "405-604-9644 x109",
            "fax_number": "405-604-9689",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "201 N Broadway St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Moore",
            "state": "OK",
            "postal_code": "731605135",
            "country_code": "US",
            "telephone_number": "405-990-0816",
            "fax_number": "405-735-6116",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "JEANNE",
        "middle_name": "DEVO",
        "credential": "M.ED., LPC, LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-12",
        "last_updated": "2019-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OK",
            "license": "2534",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OK",
            "license": "1022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEANNE",
            "last_name": "FAIR",
            "middle_name": "DEVO",
            "credential": "M.ED., LPC, LADC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cheryl Sue Black, MD
• Devaron Black
• Elizabeth Walker Black
• Haley Black
• James S Black
• Jennifer Black
• John Black
• Lauren Black, LCSW, LSW-ADM
• Lichelle Mynekia Black, LPN
• Mark A Black, M.D.

• Addiction (Substance Use Disorder) Counselor in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Addiction (Substance Use Disorder) Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.