Individual provider Active NPI

Timothy Kent Peterson, LPC, LMFT

  • Marriage & Family Therapist
  • Tulsa, OK
National Provider Identifier
1114987534
Registry record updated Jan 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
594 Issued in OK
Practice address
6655 S Yale Ave
Laureate Psychiatric Clinic and Hospital
Tulsa, OK 74136-3326
Phone
(918) 481-4000
Fax
(918) 491-5740
NPI assigned
Mar 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 2899 OK
Marriage & Family Therapist 106H00000X 594 OK Primary

Addresses

Primary practice location

6655 S Yale Ave
Laureate Psychiatric Clinic and Hospital
Tulsa, OK 74136-3326

Mailing address

6655 S Yale Ave
Laureate Psychiatric Clinic and Hospital
Tulsa, OK 74136-3326
Phone (918) 481-4000

Other identifiers 1

IdentifierTypeStateIssuer
2075927OtherCIGNA BEHAVIORAL HEALTH

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
I20240104001662 OK Practitioner - Mental Health Counselor 8820449804 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Laureate Psychiatric Clinic and Hospital IncGroup PAC ID 3971599218, 78 clinicians

Practice addresses (Care Compare)

6655 S Yale Ave
Tulsa, OK 74136-3326
Phone (918) 481-4000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2899OKMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Laureate Psychiatric Clinic and Hospital Inc CurrentSince Jan 1, 2024 Accepting new patients

Locations

6600 S Yale Ave
Ste 1200
Tulsa, OK 74136
Phone (918) 488-6045

6600 S Yale Ave
Ste 600
Tulsa, OK 74136
Phone (918) 491-5990

6655 S Yale Ave
Tulsa, OK 74136
Phone (918) 481-4000

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.

NPI Registry JSON

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

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485820800000",
    "number": "1114987534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6655 S YALE AVE",
            "address_2": "LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741363326",
            "telephone_number": "918-481-4000",
            "fax_number": "918-491-5740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6655 S YALE AVE",
            "address_2": "LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741363326",
            "telephone_number": "918-481-4000",
            "fax_number": "918-491-5740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "TIMOTHY",
        "middle_name": "KENT",
        "credential": "LPC, LMFT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-28",
        "last_updated": "2017-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OK",
            "license": "2899",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "OK",
            "license": "594",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA BEHAVIORAL HEALTH",
            "identifier": "2075927",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.