Active NPI
Richarad Allyn Walton Jr., PHD
- Clinical Child & Adolescent Psychologist
- Tulsa, OK
National Provider Identifier
1619904448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 508
- Practice address
- 5110 S Yale Ave
Suite 103
Tulsa, OK 74135-7401 - Phone
- (918) 779-7637
- Fax
- (918) 938-6037
- NPI assigned
- Jun 27, 2006
- Last updated
- Jun 28, 2008
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | 508 | OK | Primary |
Addresses
Primary practice location
5110 S Yale Ave
Suite 103
Tulsa, OK 74135-7401
Mailing address
5110 S Yale Ave
Suite 103
Tulsa, OK 74135-7401
Phone (918) 779-7637
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100840000A | 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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 508 | OK | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214611200000",
"number": "1619904448",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5110 S YALE AVE",
"address_2": "SUITE 103",
"city": "TULSA",
"state": "OK",
"postal_code": "741357401",
"telephone_number": "918-779-7637",
"fax_number": "918-938-6037"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5110 S YALE AVE",
"address_2": "SUITE 103",
"city": "TULSA",
"state": "OK",
"postal_code": "741357401",
"telephone_number": "918-779-7637",
"fax_number": "918-938-6037"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTON",
"first_name": "RICHARAD",
"middle_name": "ALLYN",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-27",
"last_updated": "2008-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "OK",
"license": "508",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100840000A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tulsa, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.