Shemaiah Davis, LPC
Individual provider Active NPI Mental Health Counselor · Jay, OK
NPI 1619448263 · NPPES record last updated Jun 20, 2024
Key facts
- NPI
- 1619448263
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 12185 (OK)
- Practice address
- 1015 W Washbourne St
Jay, OK 74346-4205 - Phone
- (918) 308-5513
- Fax
- (918) 253-6645
- NPI assigned
- Dec 7, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Grand Lake Mental Health Center, Inc.
Practice addresses (Care Compare)
1015 W Washbourne St
Jay, OK 74346-4205
Phone (918) 381-9090
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240925003565 | OK | Practitioner - Mental Health Counselor | 4385185776 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12185 | OK | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grand Lake Mental Health Center, Inc. | Current |
Accepting new patients | |
| Grand Lake Mental Health Center, Inc. | Current |
Accepting new patients | |
| Grand Lake Mental Health Center, Inc. | Current | Accepting new patients | |
| Northeastern Oklahoma Council on Alcoholism, Inc. | Past | Accepting new patients |
Locations
1015 W Washbourne St
Jay, OK 74346
Phone (918) 253-4271
111 S Treaty Rd
Miami, OK 74354
Phone (918) 540-1511
114 W Delaware Ave
Nowata, OK 74048
Phone 91827318412207
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Mental Health Counselor | 101YM0800X | 12185 | OK | Yes |
Addresses
Primary practice location
1015 W Washbourne St
Jay, OK 74346-4205
Mailing address
1015 W Washbourne St
Jay, OK 74346-4205
Phone (918) 308-5513
Other providers in Jay, OK
- Ronna M Crosby
- Crysta Nicole Cunningham
- Stacy Denise Custer
- Addison Davis
- David Josiah Davis
- Kaylee Delatorre
- Delaware County Friendship Homes Inc
- Adrianna Joy Denny
- Natasha Dobbs
- Aaron Michael Dorland
All providers in Jay, OK · Mental Health Counselor in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.