Dwain A Pellebon, PHD, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6098 Issued in OK

Practice address

2500 Boardwalk Ste 210
Norman, OK 73069-6593

Phone

(405) 857-8357

Fax

(405) 857-1678

NPI assigned

Jan 16, 2014

Last updated

May 18, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Positive Outcomes Therapeutic Services, LLC

  • Clinical Social Worker
  • Norman, OK
  • NPI 1861966814
  Medicare reassignment NPD Authorized official
• Shelli S. Jackson, PHD, PLLC

  • Counseling Psychologist
  • Norman, OK
  • NPI 1760847255
  NPD

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

{
    "created_epoch": "1389830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652832000000",
    "number": "1720400351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2227 IOWA ST",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730696520",
            "telephone_number": "405-255-8503",
            "fax_number": "405-857-1678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 BOARDWALK STE 210",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730696593",
            "telephone_number": "405-857-8357",
            "fax_number": "405-857-1678"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1330 N Classen Blvd",
            "address_2": "Suite 302",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731066835",
            "country_code": "US",
            "telephone_number": "405-606-4441",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PELLEBON",
        "first_name": "DWAIN",
        "middle_name": "A",
        "credential": "PHD, LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-01-16",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OK",
            "license": "6098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Peacock, C.R.N.A.
• Amy Pearcy
• Brenda Fay Peaster, LCSW
• Pediatric Communication Solutions, Inc
• Penny Lea Pelkey, PRSS
• Theresa Pelton
• Todd Bradford Pelton, PAC
• Pelvic Care Physical Therapy, LLC
• Alisha Ranee Pence
• Sabrina Pence

• Clinical Social Worker in Norman, OK
• Providers in Norman, 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 May 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.