Individual provider Active NPI

Mariah Buchanan

  • Professional Counselor
  • Oklahoma City, OK
National Provider Identifier
1417593773
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
11170 Issued in OK
Practice address
5208 W Reno Ave
Oklahoma City, OK 73127-6344
Phone
(405) 948-4900
Fax
(405) 948-4933
NPI assigned
Nov 21, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X
CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101Y00000X OK
Case Manager/Care Coordinator 171M00000X
Professional Counselor 101YP2500X 11170 OK Primary

Addresses

Primary practice location

5208 W Reno Ave
Oklahoma City, OK 73127-6344

Mailing address

4913 W Reno Ave
Oklahoma City, OK 73127-6339
Phone (405) 948-4900

Other practice location 1

620 NW 5th St Ste D
Moore, OK 73160-3947
Phone (405) 208-4469

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20240905000263 TX Practitioner - Mental Health Counselor 7113467101 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Oklahoma American Indian Health Council, Inc.Group PAC ID 3476617374, 60 clinicians

Practice addresses (Care Compare)

5208 W Reno Ave
Oklahoma City Indian Clinic
Oklahoma City, OK 73128-1112
Phone (405) 948-4900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11170OKMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Integrated Therapy Solutions of Oklahoma, LLC Single Specialty CurrentSince Oct 3, 2022 Accepting new patients
Central Oklahoma American Indian Health Council, Inc. Single Specialty CurrentSince Sep 3, 2024 Accepting new patients

Locations

620 NW 5th St
Ste D
Moore, OK 73160

4913 W Reno Ave
Oklahoma City, OK 73127
Phone (405) 948-4900

5208 W Reno Ave
Oklahoma City, OK 73127
Phone (405) 948-4900

309 S Ann Arbor Ave
Oklahoma City, OK 73128
Phone (405) 948-4900

Organizations & group practices 2

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": "1574294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1417593773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4913 W RENO AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731276339",
            "telephone_number": "405-948-4900",
            "fax_number": "405-948-4933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5208 W RENO AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731276344",
            "telephone_number": "405-948-4900",
            "fax_number": "405-948-4933"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "620 NW 5th St Ste D",
            "address_purpose": "LOCATION",
            "city": "Moore",
            "state": "OK",
            "postal_code": "731603947",
            "country_code": "US",
            "telephone_number": "405-208-4469",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUCHANAN",
        "first_name": "MARIAH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-21",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor",
            "state": "OK",
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OK",
            "license": "11170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.