AUDREY FORTENBERRY (NPI# 1164763280) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164763280 |
| Entity Type | Individual |
| Full Name | AUDREY FORTENBERRY |
| Practice Address |
1728 S Carson Ave Tulsa OK 74119-4610 |
| Mailing Address |
1706 N Santa Fe Ave Tulsa OK 74127-2530 |
| Practice Telephone | 9186073932 |
| Mailing Telephone | 9185278423 |
| Enumeration Date | 2013-03-14 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 200287120A | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 6202 S Lewis Ave Ste H, Tulsa, OK 741361064 | 9189499086 |
| Street Address |
1728 S CARSON AVE |
| City | TULSA |
| State | OK |
| Zip Code | 74119-4610 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013114941 | Cindy B Smith | Counselor | 1728 S Carson Ave, Tulsa, OK 74119-4610 | 2007-07-03 |
| 1548875743 | Jeffrey L Thompson | Case Manager/Care Coordinator | 1728 S Carson Ave, Tulsa, OK 74119-4610 | 2020-09-14 |
| 1356966568 | Clara Anderson | Case Manager/Care Coordinator | 1728 S Carson Ave, Tulsa, OK 74119-4610 | 2020-06-12 |
| 1134766124 | Crystal Ifekoya | Case Manager/Care Coordinator | 1728 S Carson Ave, Tulsa, OK 74119-4610 | 2019-12-09 |
| 1144879990 | Stillman Stewart | Case Manager/Care Coordinator | 1728 S Carson Ave, Tulsa, OK 74119-4610 | 2019-09-04 |
| 1932769254 | Shaycoya Proctor | Case Manager/Care Coordinator | 1728 S Carson Ave, Tulsa, OK 74119-4610 | 2019-06-18 |
| 1891223384 | Sharita Yarbrough | Counselor | 1728 S Carson Ave, Tulsa, OK 74119-4610 | 2017-05-26 |
| 1508397357 | Leslie Bevens | Counselor | 1728 S Carson Ave, Tulsa, OK 74119-4610 | 2017-03-23 |
| 1679905814 | Wendy Diane Short | Case Manager/Care Coordinator | 1728 S Carson Ave, Tulsa, OK 74119-4610 | 2013-07-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518413848 | Rashawnda Eshelle Broom | Community Health Worker | 1870 S. Boulder, Tulsa, OK 74119 | 2016-08-28 |
| 1740736115 | Kendrea Zellers | Counselor | 1516 South Boston Ave, Tulsa, OK 74119 | 2016-08-26 |
| 1528410297 | Andrea Cheree Walker | Counselor | 1541 Riverside Drive, Tulsa, OK 74119 | 2016-07-06 |
| 1851712459 | Bennett William Mcralip Jr. | Student in an Organized Health Care Education/Training Program | 1729 S. Baltimore Ave, Tulsa, OK 74119 | 2013-12-27 |
| 1932459302 | Isaac James Almaguer | Marriage & Family Therapist | 1516 S. Boston Ave, Suite 1, Tulsa, OK 74119 | 2012-09-13 |
| 1962721266 | Kimberly Dawn See | Counselor | 1516 South Boston Avenue, Tulsa, OK 74119 | 2010-05-26 |
| 1487879136 | G.thang Khan Kham | Counselor | 616 S.boston Suite #400, Tulsa, OK 74119 | 2007-04-16 |
| 1114447117 | Alyssa Orcutt | Counselor | 1870 S Boulder Ave, Tulsa, OK 74119 | 2017-06-21 |
| 1497152615 | Kristine Anne Runfola | Social Worker | 1608 S Elwood Ave, Tulsa, OK 74119 | 2014-12-03 |
| 1124445028 | Lauren Priester | Counselor | 1421 S Boston Ave, Tulsa, OK 74119 | 2014-03-28 |
| Find all providers in zip 74119 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437761004 | Ashley Jane Runnells | Counselor | 4867 S Sheridan Rd Ste 712a, Tulsa, OK 74145-5721 | 2020-08-17 |
| 1598316168 | Ryan David Sharpe | Counselor | 8218 S 77th East Ave Apt 1082, Tulsa, OK 74133-3966 | 2019-09-25 |
| 1588137780 | Hailee Dean Monroe | Counselor | 4103 S Yale Ave, Tulsa, OK 74135-6002 | 2019-01-10 |
| 1104308212 | Tawnya Denise Henderson | Counselor | 223 E Woodrow Pl, Tulsa, OK 74106-3729 | 2018-09-05 |
| 1003395617 | Crystal L Moore | Counselor | 8725 Point Dr, Tulsa, OK 74131-4028 | 2018-08-14 |
| 1386146660 | Breanna White | Counselor | 7541 S Mingo Rd Apt 7154, Tulsa, OK 74133-3384 | 2018-03-02 |
| 1699285015 | Christina M Smalley | Counselor | 600 Civic Ctr, Tulsa, OK 74103-3829 | 2017-10-11 |
| 1700395902 | Rachel Lynn Richardson | Counselor | 5800 E Skelly Dr Ste 1100, Tulsa, OK 74135-6448 | 2017-09-20 |
| 1023538014 | Milton Dean IIi | Counselor | 1234 N Rosedale, Tulsa, OK 74127 | 2017-06-21 |
| 1659800019 | Welena-phay Kamamma Boren | Counselor | 4636 S Harvard Avenue, Tulsa, OK 74135 | 2017-06-08 |
| Find all providers in TULSA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.