Active NPI
Mystic D Crenshaw
- Counselor
- Broken Arrow, OK
National Provider Identifier
1366740680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 3100 S Elm PL Ste B
Broken Arrow, OK 74012-7950 - Phone
- (918) 286-2535
- Fax
- (918) 286-7693
- NPI assigned
- Mar 10, 2011
- Last updated
- Mar 10, 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | Primary |
Addresses
Primary practice location
3100 S Elm PL Ste B
Broken Arrow, OK 74012-7950
Mailing address
1008 N Cherokee Ave
Claremore, OK 74017-5839
Phone (918) 798-5326
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1299715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1299715200000",
"number": "1366740680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1008 N CHEROKEE AVE",
"city": "CLAREMORE",
"state": "OK",
"postal_code": "740175839",
"telephone_number": "918-798-5326"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3100 S ELM PL STE B",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740127950",
"telephone_number": "918-286-2535",
"fax_number": "918-286-7693"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRENSHAW",
"first_name": "MYSTIC",
"middle_name": "D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-03-10",
"last_updated": "2011-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Mar 10, 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.