Active NPI
Regina Sue Peck, LPC
- Professional Counselor
- Wister, OK
National Provider Identifier
1861697062
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6716
- Practice address
- 23610 Wolf Valley Rd
Wister, OK 74966-2945 - Phone
- (918) 647-1924
- NPI assigned
- Jun 18, 2007
- Last updated
- Feb 3, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Professional Counselor | 101YP2500X | 6716 | OK | Primary |
Addresses
Primary practice location
23610 Wolf Valley Rd
Wister, OK 74966-2945
Mailing address
23610 Wolf Valley Rd
Wister, OK 74966-2945
Phone (918) 647-1924
Other names 1
- Regina Sue Smith
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6716 | OK | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mindful Well Being Counseling Services LLC | Current | Accepting new patients |
Locations
502 Dewey Ave
Poteau, OK 74953
Phone (918) 647-2372
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Poteau, OK
- NPI 1083253819
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580688000000",
"number": "1861697062",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23610 WOLF VALLEY RD",
"city": "WISTER",
"state": "OK",
"postal_code": "749662945",
"telephone_number": "918-647-1924"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23610 WOLF VALLEY RD",
"city": "WISTER",
"state": "OK",
"postal_code": "749662945",
"telephone_number": "918-647-1924"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PECK",
"first_name": "REGINA",
"middle_name": "SUE",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-18",
"last_updated": "2020-02-03",
"certification_date": "2020-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OK",
"license": "6716",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "REGINA",
"last_name": "SMITH",
"middle_name": "SUE",
"credential": "LPC",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Wister, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2020; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.