Lanny Ray Endicott, LCSW, LMFT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LCSW 296 Issued in OK

Practice address

3631 S Elm PL
Broken Arrow, OK 74011-1856

Phone

(918) 557-8789

NPI assigned

Nov 1, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• South Peoria Neighborhood Connection Foundation

  • Community/Behavioral Health Agency
  • Tulsa, OK
  • NPI 1649549338
  NPD (past) Authorized official

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

{
    "created_epoch": "1320105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641772800000",
    "number": "1386920585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1208 E 58TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741058401",
            "telephone_number": "918-742-5597",
            "fax_number": "918-742-4485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3631 S ELM PL",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740111856",
            "telephone_number": "918-557-8789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENDICOTT",
        "first_name": "LANNY",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "LCSW, LMFT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-11-01",
        "last_updated": "2022-01-10",
        "certification_date": "2022-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OK",
            "license": "LMFT 328",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OK",
            "license": "LCSW 296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandria Nicole Elrhazoui
• Clinton Wade Emerson, D.M.D.
• Meagan Emerson
• Carol Deann Empson, LPN
• Carol J. Enders, OTR/L
• Eugene NMN Eng, PHARM.D., D.PH.
• Crystal Engles
• Peytyn Engles
• Corneshia Shantel English
• Denise Evyonne Engram

• Mental Health Counselor in Broken Arrow, OK
• Providers in Broken Arrow, OK by specialty
• Mental Health Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 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.

Verify at the official NPI Registry.