Active NPI
Audre K Medlock, LPC
- Professional Counselor
- Phoenix, AZ
National Provider Identifier
1346972270
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC-19716
- Practice address
- 14040 N Cave Creek Rd # 108
Phoenix, AZ 85022-6117 - Phone
- (602) 358-7073
- Fax
- (888) 927-0409
- NPI assigned
- Jun 29, 2022
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC-19716 | AZ | Primary |
Addresses
Primary practice location
14040 N Cave Creek Rd # 108
Phoenix, AZ 85022-6117
Mailing address
23380 N 61St Dr
Glendale, AZ 85310-5748
Phone (602) 358-7073
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LPC-19716 | Other | AZ | AZ BOARD OF BEHAVIORAL HEALTH LICENSE |
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)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oceanbee Wellness, LLC | Professional | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1656460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656460800000",
"number": "1346972270",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23380 N 61ST DR",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853105748",
"telephone_number": "602-358-7073",
"fax_number": "888-927-0409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14040 N CAVE CREEK RD # 108",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850226117",
"telephone_number": "602-358-7073",
"fax_number": "888-927-0409"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDLOCK",
"first_name": "AUDRE",
"middle_name": "K",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-06-29",
"last_updated": "2022-06-29",
"certification_date": "2022-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AZ",
"license": "LPC-19716",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AZ BOARD OF BEHAVIORAL HEALTH LICENSE",
"identifier": "LPC-19716",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.