NPIMap

Organization Active NPI

Brenda Sue Mathis

  • Mental Illness Community Based Residential Treatment Facility
  • Broken Arrow, OK
National Provider Identifier
1215261086
Registry record updated Sep 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
BRENDA SUE MATHIS
Doing business as
Brenda Sue Mathis
Practice address
4034 W Roanoke PL
Broken Arrow, OK 74011-1327
Phone
(918) 698-7171
NPI assigned
Sep 28, 2009
Last updated
Sep 28, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2009

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

Authorized official

Name
Ms. Brenda Sue Mathis, MAMFTNPI 1639853815
Title
Owner
Phone
(918) 698-7171

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X OK Primary
Psychiatric Residential Treatment Facility 323P00000X OK
Substance Abuse Rehabilitation Facility 324500000X OK

Addresses

Primary practice location

4034 W Roanoke PL
Broken Arrow, OK 74011-1327

Mailing address

4034 W Roanoke PL
Broken Arrow, OK 74011-1327
Phone (918) 698-7171

Other names 1

  • Brenda Sue Mathis Doing business as

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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1254096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254096000000",
    "number": "1215261086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4034 W ROANOKE PL",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740111327",
            "telephone_number": "918-698-7171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4034 W ROANOKE PL",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740111327",
            "telephone_number": "918-698-7171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRENDA SUE MATHIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-28",
        "last_updated": "2009-09-28",
        "status": "A",
        "authorized_official_last_name": "MATHIS",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-698-7171",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MAMFT"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "OK",
            "license": null,
            "primary": true
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "OK",
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "OK",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brenda Sue Mathis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Broken Arrow, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2009; 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.