Roger Dewayne Willis

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

109 S Harrill Ave
Wagoner, OK 74467-5317

Phone

(918) 485-0242

Fax

(918) 485-0204

NPI assigned

Aug 15, 2025

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1755216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755216000000",
    "number": "1598641367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4103 S YALE AVE STE B",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741356002",
            "telephone_number": "918-382-7300",
            "fax_number": "918-382-7302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 S HARRILL AVE",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744675317",
            "telephone_number": "918-485-0242",
            "fax_number": "918-485-0204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "ROGER",
        "middle_name": "DEWAYNE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-08-15",
        "last_updated": "2025-08-15",
        "certification_date": "2025-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fayette Louise Wiley
• Kari Lynn Wilkerson, OD
• Lanica Willaby
• William R Homan
• Debra Williams
• Jennifer C Wilson
• Tyra Lee Wilson
• Anthony Wineland
• Ashley M Wood
• Kyle Woodson, MD

• Mental Health Counselor in Wagoner, OK
• Providers in Wagoner, OK by specialty
• Mental Health Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 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.

Verify at the official NPI Registry.