Active NPI
Marya Allen, LMLP, LMAC, LBP
- Mental Health Counselor
- Blackwell, OK
National Provider Identifier
1992747968
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 10397
- Practice address
- 1313 W Ferguson Ave
Blackwell, OK 74631-5604 - Phone
- (580) 363-4400
- NPI assigned
- Jun 12, 2006
- Last updated
- Dec 29, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1237 | KS | |
| Mental Health Counselor | 101YM0800X | 10397 | OK | Primary |
| Clinical Psychologist | 103TC0700X | 728 | KS |
Addresses
Primary practice location
1313 W Ferguson Ave
Blackwell, OK 74631-5604
Mailing address
1313 W Ferguson Ave
Blackwell, OK 74631-5604
Phone (580) 363-4400
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 389893 | Other | KS | BLUE CROSS BLUE SHIELD |
| 12989 | Other | KS | PREFERRED HEALTH SYSTEMS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10397 | OK | MD | Mental Health Counselor |
| 1237 | KS | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Sedgwick | Addiction (Substance Use Disorder) | Past | Accepting new patients |
| County of Sedgwick | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba COMCARE Addiction Treatment Services
- Addiction (Substance Use Disorder) Counselor
- Wichita, KS
- NPI 1376624775
-
dba Central Plains Area Agency on Aging
- Case Management Agency
- Wichita, KS
- NPI 1679610539
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640736000000",
"number": "1992747968",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1313 W FERGUSON AVE",
"city": "BLACKWELL",
"state": "OK",
"postal_code": "746315604",
"telephone_number": "580-363-4400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1313 W FERGUSON AVE",
"city": "BLACKWELL",
"state": "OK",
"postal_code": "746315604",
"telephone_number": "580-363-4400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALLEN",
"first_name": "MARYA",
"credential": "LMLP, LMAC, LBP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-12",
"last_updated": "2021-12-29",
"certification_date": "2021-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "KS",
"license": "1237",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OK",
"license": "10397",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "KS",
"license": "728",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "389893",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED HEALTH SYSTEMS",
"identifier": "12989",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Blackwell, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.