Mylinda Renee Fanj, M.S., LPC (US)

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

(US) 966 Issued in OK

Practice address

109 S Harrill Ave
Wagoner, OK 74467-5317

Phone

(918) 485-3554

NPI assigned

Oct 25, 2011

Last updated

Oct 25, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Community Pathways Unlimited Inc

  • Clinical Psychologist
  • Oklahoma City, OK
  • NPI 1659328284
  Medicare reassignment NPD

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

{
    "created_epoch": "1319500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319500800000",
    "number": "1255617015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 S HARRILL AVE",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744675317",
            "telephone_number": "918-485-3554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 S HARRILL AVE",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744675317",
            "telephone_number": "918-485-3554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANJ",
        "first_name": "MYLINDA",
        "middle_name": "RENEE",
        "credential": "M.S., LPC (US)",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-25",
        "last_updated": "2011-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OK",
            "license": "(US) 966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Ann Edwards
• Cortez De'Angelo Edwards
• Melissa Ellis
• Emerald First Choice Hospice LLC (Emerald Hospice II)
• Jeffrey K Evans, MD
• Elizabeth Farar
• Farmer Family Practice
• Jennifer Anne Farmer, ARNP-CNP
• Robyn Farmer, APRN-CNP
• Stephanie Ann Ferrer

• Professional Counselor in Wagoner, OK
• Providers in Wagoner, OK by specialty
• Professional Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.