Active NPI
Samantha Ezell
- Mental Health Counselor
- Ardmore, OK
National Provider Identifier
1487199527
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 115 W Broadway St
401
Ardmore, OK 73401-6205 - Phone
- (580) 226-5209
- Fax
- (580) 226-5219
- NPI assigned
- Dec 28, 2016
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
115 W Broadway St
401
Ardmore, OK 73401-6205
Mailing address
PO Box 1710
Kingston, OK 73439-1710
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeastern Oklahoma Family Services, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Ardmore, OK
- NPI 1346575883
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1482883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1482883200000",
"number": "1487199527",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1710",
"city": "KINGSTON",
"state": "OK",
"postal_code": "734391710"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 W BROADWAY ST",
"address_2": "401",
"city": "ARDMORE",
"state": "OK",
"postal_code": "734016205",
"telephone_number": "580-226-5209",
"fax_number": "580-226-5219"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EZELL",
"first_name": "SAMANTHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-12-28",
"last_updated": "2016-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ardmore, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.