BRENDA SUE MATHIS (NPI# 1215261086) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1215261086 |
Entity Type | Organization |
Organization Name | BRENDA SUE MATHIS |
Other Organization Name | BRENDA SUE MATHIS |
Practice Address |
4034 W Roanoke Pl Broken Arrow OK 74011-1327 |
Practice Telephone | 9186987171 |
Mailing Telephone | 9186987171 |
Enumeration Date | 2009-09-28 |
Last Update Date | 2009-09-28 |
Authorized Official Name | MS. BRENDA SUE MATHIS (OWNER) |
Authorized Official Telephone | 9186987171 |
Authorized Official Credential | MAMFT |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 323P00000X | Psychiatric Residential Treatment Facility | OK | Residential Treatment Facilities | |
N | 324500000X | Substance Abuse Rehabilitation Facility | OK | Residential Treatment Facilities | |
Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | OK | Residential Treatment Facilities |
Other Name | Type Code |
---|---|
Brenda Sue Mathis | Doing Business As Name - Organization |
Street Address |
4034 W ROANOKE PL |
City | BROKEN ARROW |
State | OK |
Zip Code | 74011-1327 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1336663699 | Cpii, LLC | Pharmacy | 811 W. New Orleans, Ste 101, Broken Arrow, OK 74011 | 2017-07-28 |
1053833608 | Cpii, LLC | Pharmacy | 811 W. New Orleans, Suite 101, Broken Arrow, OK 74011 | 2017-07-14 |
1184079709 | Melissa David | Lactation Consultant, Non-RN | 417 West San Diego St., Broken Arrow, OK 74011 | 2016-05-02 |
1154789576 | Rebecca Young | Registered Nurse | 7801 S Oak Pl, Broken Arrow, OK 74011 | 2016-01-29 |
1942524061 | Oklahoma Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 751 W Tuscan St, 121st, Broken Arrow, OK 74011 | 2010-03-18 |
1174764336 | Linda J. Russell | Counselor | 2446 W New Orleans St, Broken Arrow, OK 74011 | 2009-03-18 |
1851409080 | Kim Lee Mcneal | Dentist | 3764 South Elm Place, Broken Arrow, OK 74011 | 2006-08-28 |
1669433249 | Matthew E Ozment | Optometrist | 2500 West New Orleans, Broken Arrow, OK 74011 | 2006-03-31 |
1912275140 | Courtney Brooke Willcoxon | Pharmacist | 4704 S Elm Pl, Broken Arrow, OK 74011 | 2011-12-02 |
1558322883 | Gerald Seefeldt | Family Medicine | 66 Cedar Ridge Rd, Broken Arrow, OK 74011-1101 | 2006-03-28 |
Find all providers in zip 74011 |
Taxonomy Code | 320800000X |
Grouping | Residential Treatment Facilities |
Classification | Community Based Residential Treatment Facility, Mental Illness |
A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
Notes: [7/1/2003: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1801321070 | April Brock | Community Based Residential Treatment Facility, Mental Illness | 106 12th Ave Ne, Miami, OK 74354-3373 | 2017-04-25 |
1114321486 | Cedric Glenn | Community Based Residential Treatment Facility, Mental Illness | 1721 E 72nd St, 1803, Tulsa, OK 74136-5372 | 2014-10-15 |
1083058523 | Mongo Allen | Community Based Residential Treatment Facility, Mental Illness | 829 Nw 142nd St, Edmond, OK 73013-1962 | 2013-04-27 |
1801133236 | Southeastern Oklahoma Family Services | Community Based Residential Treatment Facility, Mental Illness | 1501 N Washington Ave, Durant, OK 74701-2127 | 2013-01-04 |
1043595879 | Oaktree Counseling Services | Community Based Residential Treatment Facility, Mental Illness | 2104 Nw Britni Cir, Lawton, OK 73505-3121 | 2011-10-12 |
1790089829 | Southern Oklahoma Treatment Services | Community Based Residential Treatment Facility, Mental Illness | 5862 Us Hwy 70, Mead, OK 73449 | 2011-01-04 |
1285966747 | Dr. C Professional Services, Pllc | Community Based Residential Treatment Facility, Mental Illness | 7109 S Kentucky Ave, Oklahoma City, OK 73159-3427 | 2010-02-09 |
1881921898 | Sequoyah Residential Mental Health Facility, Inc | Community Based Residential Treatment Facility, Mental Illness | 103 N Wheeler Ave, Sallisaw, OK 74955-4617 | 2009-11-11 |
1790922185 | State of Oklahoma | Community Based Residential Treatment Facility, Mental Illness | 2323 South Harvard, Tulsa, OK 74114 | 2009-01-07 |
1558570309 | Meadow Brook Residential Care Facility | Community Based Residential Treatment Facility, Mental Illness | 1000 Meadow Lane, Howe, OK 74940 | 2007-05-21 |
Find all providers with the same taxonomy |
City | BROKEN ARROW |
Zip Code | 74011 |
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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.