Organization Active NPI

Personal Revolutions Behavioral Health Services, LLC

  • Professional Counselor
  • Oklahoma City, OK
National Provider Identifier
1164939765
Registry record updated Feb 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
6323 Issued in OK
Legal business name
PERSONAL REVOLUTIONS BEHAVIORAL HEALTH SERVICES, LLC
Practice address
6801 S Western Ave Ste 101
Oklahoma City, OK 73139-1816
Phone
(405) 550-2688
Fax
(405) 619-3924
NPI assigned
Jan 4, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2026

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

Authorized official

Name
Krystal Dawn Haltom, M.A., LPC SUPERVISOR
Title
Owner
Phone
(405) 550-2688

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X 6323 OK Primary

Addresses

Primary practice location

6801 S Western Ave Ste 101
Oklahoma City, OK 73139-1816

Mailing address

6801 S Western Ave Ste 101
Oklahoma City, OK 73139-1816
Phone (405) 550-2688

Other identifiers 1

IdentifierTypeStateIssuer
2003754400BMedicaidOK

Other names 1

  • Krystal Haltom Doing business as

National Provider Directory

National Provider Directory

Locations

6801 S Western Ave
Ste 101
Oklahoma City, OK 73139
Phone (405) 254-6047

6801 S Western Ave
Ste 203
Oklahoma City, OK 73139
Phone (405) 245-7059

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": "1515024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771891200000",
    "number": "1164939765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6801 S WESTERN AVE STE 101",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731391816",
            "telephone_number": "405-550-2688",
            "fax_number": "405-619-3924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6801 S WESTERN AVE STE 101",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731391816",
            "telephone_number": "405-550-2688",
            "fax_number": "405-619-3924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERSONAL REVOLUTIONS BEHAVIORAL HEALTH SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-04",
        "last_updated": "2026-02-24",
        "certification_date": "2026-02-24",
        "status": "A",
        "authorized_official_last_name": "HALTOM",
        "authorized_official_first_name": "KRYSTAL",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-550-2688",
        "authorized_official_credential": "M.A., LPC SUPERVISOR"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "OK",
            "license": "6323",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2003754400B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Krystal Haltom",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2026; 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.