Brandi D Detherow, LCSW PROVISIONAL

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

NONE Issued in OK

Practice address

15 E Dewey Ave
Sapulpa, OK 74066-4201

Phone

(918) 227-2016

Fax

(918) 227-1125

NPI assigned

Apr 23, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Clinical Social Worker

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Improving Lives Counseling Services IncGroup PAC ID 3870818230, 32 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Improving Lives Counseling Services, Inc.

  • Community/Behavioral Health Agency
  • Tulsa, OK
  • NPI 1487967444
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1538387410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "832 W COMMERCIAL ST.",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "74012",
            "telephone_number": "918-607-3444",
            "fax_number": "918-227-1125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 E DEWEY AVE",
            "city": "SAPULPA",
            "state": "OK",
            "postal_code": "740664201",
            "telephone_number": "918-227-2016",
            "fax_number": "918-227-1125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETHEROW",
        "first_name": "BRANDI",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "credential": "LCSW PROVISIONAL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OK",
            "license": "NONE",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janea Dennis
• Jennifer Denton
• Derstine Chiropractic Clinic
• Thomas A Derstine, DC
• Shea Lyn Despain, APRN
• Aida Araceli Dicken
• Anthony Diskin, DDS
• Divine Health and Wellness, LLC
• Mai Thi DO
• Dayen Ann Dooley

• Clinical Social Worker in Sapulpa, OK
• Providers in Sapulpa, OK by specialty
• Clinical Social Worker in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.