Regina Sue Peck, LPC
Individual provider Active NPI Professional Counselor · Wister, OK
NPI 1861697062 · NPPES record last updated Feb 3, 2020
Key facts
- NPI
- 1861697062
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 6716 (OK)
- Practice address
- 23610 Wolf Valley Rd
Wister, OK 74966-2945 - Phone
- (918) 647-1924
- NPI assigned
- Jun 18, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250109003213 | OK | Practitioner - Mental Health Counselor | 0345778924 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6716 | OK | MD | Dentist |
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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Professional Counselor | 101YP2500X | 6716 | OK | Yes |
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
- Regina Sue Smith
Other providers in Wister, OK
- Kim Evans
- Melinda Sue Greer
- Diana NA Hames
- Makayla Hubbard
- Linda K McGowen
- Kacee Jade Place
- Mary Qualls
- Misti Kay Roath
- Marenda Rachelle Singleterry
- Frankie Cheryl Sisson
All providers in Wister, OK · Professional Counselor in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.