Active NPI
Talesa Damariz Wilson
- Marriage & Family Therapist
- Yukon, OK
National Provider Identifier
1457212334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- Practice address
- 416 S Mustang Rd Ste B
Yukon, OK 73099-7314 - Phone
- (405) 254-7746
- NPI assigned
- Nov 20, 2025
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | OK | Primary |
Addresses
Primary practice location
416 S Mustang Rd Ste B
Yukon, OK 73099-7314
Mailing address
2307 N Thompkins Ave Apt S5
Bethany, OK 73008-5334
Other practice location 1
2206 N Kickapoo Ave
Shawnee, OK 74804-2703
Phone (405) 585-4530
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": "1763596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1763596800000",
"number": "1457212334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2307 N THOMPKINS AVE APT S5",
"city": "BETHANY",
"state": "OK",
"postal_code": "730085334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "416 S MUSTANG RD STE B",
"city": "YUKON",
"state": "OK",
"postal_code": "730997314",
"telephone_number": "405-254-7746"
}
],
"practiceLocations": [
{
"address_1": "2206 N Kickapoo Ave",
"address_purpose": "LOCATION",
"city": "Shawnee",
"state": "OK",
"postal_code": "748042703",
"country_code": "US",
"telephone_number": "405-585-4530",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILSON",
"first_name": "TALESA",
"middle_name": "DAMARIZ",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-11-20",
"last_updated": "2025-11-20",
"certification_date": "2025-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Marriage & Family Therapist",
"state": "OK",
"license": null,
"primary": true
}
],
"identifiers": [],
"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 Nov 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.