NPIMap

Organization Active NPI

Behavioral Modification Counseling

  • Mental Health Counselor
  • Tulsa, OK
National Provider Identifier
1124560420
Registry record updated Nov 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
4203 Issued in OK
Legal business name
BEHAVIORAL MODIFICATION COUNSELING
Practice address
4308 E 21St PL
Tulsa, OK 74114-2114
Phone
(919) 808-1000
NPI assigned
Nov 17, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2016

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

Authorized official

Name
Susanna Halcomb, LPC-SNPI 1588868855
Title
Counselor
Phone
(918) 808-1000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X 4203 OK Primary

Addresses

Primary practice location

4308 E 21St PL
Tulsa, OK 74114-2114

Mailing address

4308 E 21St PL
Tulsa, OK 74114-2114
Phone (919) 808-1000

Other identifiers 1

IdentifierTypeStateIssuer
200375600AMedicaidOK

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1479340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479340800000",
    "number": "1124560420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4308 E 21ST PL",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741142114",
            "telephone_number": "919-808-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4308 E 21ST PL",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741142114",
            "telephone_number": "919-808-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEHAVIORAL MODIFICATION COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-17",
        "last_updated": "2016-11-17",
        "status": "A",
        "authorized_official_last_name": "HALCOMB",
        "authorized_official_first_name": "SUSANNA",
        "authorized_official_title_or_position": "COUNSELOR",
        "authorized_official_telephone_number": "918-808-1000",
        "authorized_official_credential": "LPC-S"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "OK",
            "license": "4203",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200375600A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2016; 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.