Individual provider Active NPI

Tijuana Williams

  • Counselor
  • Bartlesville, OK
National Provider Identifier
1467704445
Registry record updated Oct 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Practice address
700 SW Penn Ave
Bartlesville, OK 74003-3847
Phone
(918) 337-8080
Fax
(918) 337-8099
NPI assigned
Oct 15, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X Primary

Addresses

Primary practice location

700 SW Penn Ave
Bartlesville, OK 74003-3847

Mailing address

700 SW Penn Ave
Bartlesville, OK 74003-3847
Phone (918) 337-8080

Other identifiers 1

IdentifierTypeStateIssuer
200287120AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20240325000874 OK Practitioner - Mental Health Counselor 1850738089 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7649OKMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Grand Lake Mental Health Center, Inc. CurrentSince Mar 11, 2024 Accepting new patients
Grand Lake Mental Health Center, Inc. Current Accepting new patients
Grand Lake Mental Health Center, Inc. CurrentSince Mar 11, 2024 Accepting new patients

Locations

700 S Penn Ave
Bartlesville, OK 74003
Phone (918) 337-8099

705 S Virginia Ave
Bartlesville, OK 74003
Phone (918) 231-0810

111 S Treaty Rd
Miami, OK 74354
Phone (918) 540-1511

114 W Delaware Ave
Nowata, OK 74048
Phone 91827318412207

Organizations & group practices 3

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": "1350259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634860800000",
    "number": "1467704445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 SW PENN AVE",
            "city": "BARTLESVILLE",
            "state": "OK",
            "postal_code": "740033847",
            "telephone_number": "918-337-8080",
            "fax_number": "918-337-8099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 SW PENN AVE",
            "city": "BARTLESVILLE",
            "state": "OK",
            "postal_code": "740033847",
            "telephone_number": "918-337-8080",
            "fax_number": "918-337-8099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "TIJUANA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-15",
        "last_updated": "2021-10-22",
        "certification_date": "2021-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200287120A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bartlesville, OK

Sources for this page

Verify at the official NPI Registry.