Active NPI
Meghan Theobald
- Mental Health Counselor
- Yukon, OK
National Provider Identifier
1326335142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 3638
- Practice address
- 428 S Mustang Rd
Yukon, OK 73099-6754 - Phone
- (405) 217-8400
- NPI assigned
- Jun 30, 2011
- 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 | 3638 | OK | Primary |
Addresses
Primary practice location
428 S Mustang Rd
Yukon, OK 73099-6754
Mailing address
310 12TH Ave NE
Norman, OK 73071-5238
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200253070B | Medicaid | OK |
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 |
|---|---|---|---|
| 3638 | OK | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309392000000",
"number": "1326335142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "310 12TH AVE NE",
"city": "NORMAN",
"state": "OK",
"postal_code": "730715238"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "428 S MUSTANG RD",
"city": "YUKON",
"state": "OK",
"postal_code": "730996754",
"telephone_number": "405-217-8400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THEOBALD",
"first_name": "MEGHAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-06-30",
"last_updated": "2011-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OK",
"license": "3638",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200253070B",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Yukon, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.