Phoenix Gate Inc

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

256 Issued in OK

Legal business name

PHOENIX GATE INC

Practice address

211 E Court St Ste 6
Atoka, OK 74525-2000

Phone

(580) 364-0700

Fax

(580) 364-0701

NPI assigned

Jan 8, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Prof. John E Eckenberger, LCSW, LADC, CCS

Title

Clinical Director

Phone

(580) 364-0700

Specialties & licenses 1

Addresses

Tax ID family

Phoenix Gate Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Phoenix Gate Inc

  • Case Management Agency
  • McAlester, OK
  • NPI 1871965723
  NPD tax ID
• Phoenix Gate, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • McAlester, OK
  • NPI 1962733758
  NPD tax ID

Locations

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1639227028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 E COURT ST STE 6",
            "city": "ATOKA",
            "state": "OK",
            "postal_code": "745252000",
            "telephone_number": "580-364-0700",
            "fax_number": "580-364-0701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 E COURT ST STE 6",
            "city": "ATOKA",
            "state": "OK",
            "postal_code": "745252000",
            "telephone_number": "580-364-0700",
            "fax_number": "580-364-0701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX GATE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ECKENBERGER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "580-364-0700",
        "authorized_official_name_prefix": "Prof.",
        "authorized_official_credential": "LCSW, LADC, CCS"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "OK",
            "license": "256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandie Machelle Owens
• Jesse Don Pacheco, M.B.S., LPCS
• Maverick Ray Padgett
• Patricia Ilene Padgett, B.S.
• Regina Pfaff
• Mary Elizabeth Pierce, LPC
• Rachel Pittman
• Lauren Porter
• Sonya Marie Porter, M.ED
• Jordan Powers, BHCMII

• Clinical Social Worker in Atoka, OK
• Providers in Atoka, 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 Aug 22, 2020; 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.