Active NPI
Austin Ray Matthiessen
- Counselor
- Oklahoma City, OK
National Provider Identifier
1689345316
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 11897
- Practice address
- 2617 General Pershing Blvd
Oklahoma City, OK 73107-6437 - Phone
- (405) 858-2957
- NPI assigned
- Sep 22, 2021
- Reactivated
- Oct 18, 2021
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | 11897 | OK | Primary |
Addresses
Primary practice location
2617 General Pershing Blvd
Oklahoma City, OK 73107-6437
Mailing address
PO Box 12978
Oklahoma City, OK 73157-2978
Phone (405) 858-2957
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11897 | OK | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711497600000",
"number": "1689345316",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 12978",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731572978",
"telephone_number": "405-858-2957"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2617 GENERAL PERSHING BLVD",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731076437",
"telephone_number": "405-858-2957"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTHIESSEN",
"first_name": "AUSTIN",
"middle_name": "RAY",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-09-22",
"last_updated": "2024-03-27",
"certification_date": "2024-03-27",
"deactivation_date": "2021-09-23",
"reactivation_date": "2021-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "OK",
"license": "11897",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.