Active NPI
Renee Shanna Dougherty
- Mental Health Counselor
- Ardmore, OK
National Provider Identifier
1174864847
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 171M00000X
- Practice address
- 2530 S Commerce St
Building B.
Ardmore, OK 73401-5519 - Phone
- (580) 223-2537
- NPI assigned
- Mar 6, 2013
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 171M00000X | OK | Primary |
Addresses
Primary practice location
2530 S Commerce St
Building B.
Ardmore, OK 73401-5519
Mailing address
2530 S Commerce St
Building B.
Ardmore, OK 73401-5519
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 |
|---|---|---|---|
| 171M00000X | OK | MD | Case Manager/Care Coordinator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1362528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362528000000",
"number": "1174864847",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2530 S COMMERCE ST",
"address_2": "BUILDING B.",
"city": "ARDMORE",
"state": "OK",
"postal_code": "734015519"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2530 S COMMERCE ST",
"address_2": "BUILDING B.",
"city": "ARDMORE",
"state": "OK",
"postal_code": "734015519",
"telephone_number": "580-223-2537"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGHERTY",
"first_name": "RENEE",
"middle_name": "SHANNA",
"name_prefix": "Miss",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-03-06",
"last_updated": "2013-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OK",
"license": "171M00000X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ardmore, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.