NPIMap

Organization Active NPI

Poyner Mental Health Services

  • Mental Health Counselor
  • Choctaw, OK
National Provider Identifier
1740845361
Registry record updated May 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
POYNER MENTAL HEALTH SERVICES
Practice address
14453 SE 29TH St Ste D
Choctaw, OK 73020-6543
Phone
(405) 741-2844
Fax
(405) 733-1334
NPI assigned
May 8, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2019

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

Authorized official

Name
Kimberly Nicole Woodhouse, LPCNPI 1114427267
Title
Owner
Phone
(405) 741-2844

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

14453 SE 29TH St Ste D
Choctaw, OK 73020-6543

Mailing address

14453 SE 29TH St Ste D
Choctaw, OK 73020-6543
Phone (405) 741-2844

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231201001081 OK Part B Supplier - Clinic/Group Practice 1153779145 Receives reassigned benefits from 6 practitioners
Practice locations: Choctaw, OK

National Provider Directory

National Provider Directory

Locations

14453 SE 29th St
Ste D
Choctaw, OK 73020
Phone (405) 741-2844

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1557273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557273600000",
    "number": "1740845361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14453 SE 29TH ST STE D",
            "city": "CHOCTAW",
            "state": "OK",
            "postal_code": "730206543",
            "telephone_number": "405-741-2844",
            "fax_number": "405-733-1334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14453 SE 29TH ST STE D",
            "city": "CHOCTAW",
            "state": "OK",
            "postal_code": "730206543",
            "telephone_number": "405-741-2844",
            "fax_number": "405-733-1334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POYNER MENTAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-08",
        "last_updated": "2019-05-08",
        "status": "A",
        "authorized_official_last_name": "WOODHOUSE",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-741-2844",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Choctaw, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.