Active NPI
Regina Sioux Ertz, PH.D.
- Clinical Psychologist
- Shawnee, OK
National Provider Identifier
1669957734
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1319
- Practice address
- 2307 Gordon Cooper Dr
Shawnee, OK 74801-9007 - Phone
- (405) 214-5101
- Fax
- (405) 878-5846
- NPI assigned
- Sep 25, 2018
- Sex
- Female
- 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 Psychologist | 103TC0700X | 1319 | OK | Primary |
Addresses
Primary practice location
2307 Gordon Cooper Dr
Shawnee, OK 74801-9007
Mailing address
2307 Gordon Cooper Dr
Shawnee, OK 74801-9007
Phone (405) 214-5101
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 |
|---|---|---|---|
| 1319 | OK | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537833600000",
"number": "1669957734",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2307 GORDON COOPER DR",
"city": "SHAWNEE",
"state": "OK",
"postal_code": "748019007",
"telephone_number": "405-214-5101",
"fax_number": "405-878-5846"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2307 GORDON COOPER DR",
"city": "SHAWNEE",
"state": "OK",
"postal_code": "748019007",
"telephone_number": "405-214-5101",
"fax_number": "405-878-5846"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERTZ",
"first_name": "REGINA",
"middle_name": "SIOUX",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-25",
"last_updated": "2018-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OK",
"license": "1319",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shawnee, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.