Active NPI
Richard David Davidson, MS, LADC, CRC, CVRT,
- Addiction (Substance Use Disorder) Counselor
- Broken Arrow, OK
National Provider Identifier
1992983407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- Practice address
- 3718 S Elm PL
Suite 3718
Broken Arrow, OK 74011-1803 - Phone
- (918) 994-1510
- NPI assigned
- Feb 6, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | Primary | ||
| Case Manager/Care Coordinator | 171M00000X | |||
| Rehabilitation Psychologist | 103TR0400X | |||
| Counseling Psychologist | 103TC1900X | |||
| Cognitive & Behavioral Psychologist | 103TB0200X |
Addresses
Primary practice location
3718 S Elm PL
Suite 3718
Broken Arrow, OK 74011-1803
Mailing address
3718 S Elm PL
Suite 3718
Broken Arrow, OK 74011-1803
Phone (918) 994-1510
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992983407 | Medicaid | OK |
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
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440460800000",
"number": "1992983407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3718 S ELM PL",
"address_2": "SUITE 3718",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740111803",
"telephone_number": "918-994-1510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3718 S ELM PL",
"address_2": "SUITE 3718",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740111803",
"telephone_number": "918-994-1510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIDSON",
"first_name": "RICHARD",
"middle_name": "DAVID",
"credential": "MS, LADC, CRC, CVRT,",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-02-06",
"last_updated": "2015-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": true
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TR0400X",
"taxonomy_group": "",
"desc": "Psychologist, Rehabilitation",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1992983407",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Broken Arrow, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.