NPIMap

Organization Active NPI

Affect Provider Group, P.S.C.

  • Mental Health Counselor
  • Edmond, OK
National Provider Identifier
1902795255
Registry record updated Jul 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
AFFECT PROVIDER GROUP, P.S.C.
Practice address
3209 S Broadway Ste 229
Edmond, OK 73013-4064
Phone
(845) 769-8758
NPI assigned
Jul 1, 2025
Last updated
Jul 1, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2025

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

Authorized official

Name
Karla Renee Mullings
Title
Director of Compliance
Phone
(845) 768-8758

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU Primary
Psychologist 103T00000X NU
Clinical Psychologist 103TC0700X NU
Social Worker 104100000X NU
Adult Psychiatric/Mental Health Registered Nurse 163WP0809X NU
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU
Psychiatric/Mental Health Clinical Nurse Specialist 364SP0808X NU

Addresses

Primary practice location

3209 S Broadway Ste 229
Edmond, OK 73013-4064

Mailing address

1640 Boro PL FL 4
MC Lean, VA 22102-3627
Phone (845) 769-8758

National Provider Directory

National Provider Directory
Tax ID family
Affect23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1751328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751328000000",
    "number": "1902795255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 BORO PL FL 4",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221023627",
            "telephone_number": "845-769-8758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3209 S BROADWAY STE 229",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730134064",
            "telephone_number": "845-769-8758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFFECT PROVIDER GROUP, P.S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-01",
        "last_updated": "2025-07-01",
        "certification_date": "2025-07-01",
        "status": "A",
        "authorized_official_last_name": "MULLINGS",
        "authorized_official_first_name": "KARLA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "DIRECTOR OF COMPLIANCE",
        "authorized_official_telephone_number": "845-768-8758"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "364SP0808X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmond, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.