Active NPI
Brock Neely, LCSW
- Clinical Social Worker
- Fort Sill, OK
National Provider Identifier
1164110680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 20054
- Practice address
- 4301 Wilson St
Fort Sill, OK 73503-4472 - Phone
- (405) 535-8385
- NPI assigned
- Apr 25, 2023
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 20054 | OK | Primary |
Addresses
Primary practice location
4301 Wilson St
Fort Sill, OK 73503-4472
Mailing address
3425 Superior Dr
Moore, OK 73160-2744
Phone (405) 535-8385
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20054 | OK | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1682380800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730073600000",
"number": "1164110680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3425 SUPERIOR DR",
"city": "MOORE",
"state": "OK",
"postal_code": "731602744",
"telephone_number": "405-535-8385"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4301 WILSON ST",
"city": "FORT SILL",
"state": "OK",
"postal_code": "735034472",
"telephone_number": "405-535-8385"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEELY",
"first_name": "BROCK",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-04-25",
"last_updated": "2024-10-28",
"certification_date": "2024-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OK",
"license": "20054",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Sill, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.