Active NPI
Derek Colvin, BHRS
- Professional Counselor
- Edmond, OK
National Provider Identifier
1124381777
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 7201
- Practice address
- 1732 S Kelly Ave
Edmond, OK 73013-3630 - Phone
- (405) 642-5320
- NPI assigned
- Jun 19, 2012
- Sex
- Male
- Sole proprietor
- Yes
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 | 7201 | OK | Primary |
Addresses
Primary practice location
1732 S Kelly Ave
Edmond, OK 73013-3630
Mailing address
7405 NW 121St St
Oklahoma City, OK 73162-1518
Phone (405) 642-5320
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7201 | OK | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581033600000",
"number": "1124381777",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7405 NW 121ST ST",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731621518",
"telephone_number": "405-642-5320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1732 S KELLY AVE",
"city": "EDMOND",
"state": "OK",
"postal_code": "730133630",
"telephone_number": "405-642-5320"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLVIN",
"first_name": "DEREK",
"credential": "BHRS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-19",
"last_updated": "2020-02-07",
"certification_date": "2020-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Professional",
"state": "OK",
"license": "7201",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edmond, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.