Active NPI
Jacob Brewer
- Counseling Psychologist
- Vinita, OK
National Provider Identifier
1508450149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- Practice address
- 405 E Excelsior Ave
Vinita, OK 74301-4226 - Phone
- (918) 256-6476
- NPI assigned
- Feb 24, 2021
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | Primary |
Addresses
Primary practice location
405 E Excelsior Ave
Vinita, OK 74301-4226
Mailing address
1617 D St NE
Miami, OK 74354-2743
Phone (918) 325-3641
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0HG71 | Medicaid | OK |
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": "1614124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614124800000",
"number": "1508450149",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1617 D ST NE",
"city": "MIAMI",
"state": "OK",
"postal_code": "743542743",
"telephone_number": "918-325-3641"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 E EXCELSIOR AVE",
"city": "VINITA",
"state": "OK",
"postal_code": "743014226",
"telephone_number": "918-256-6476"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BREWER",
"first_name": "JACOB",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-02-24",
"last_updated": "2021-02-24",
"certification_date": "2021-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0HG71",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vinita, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.