SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, LLC (NPI# 1316056534) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316056534 |
| Entity Type | Organization |
| Organization Name | SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, LLC |
| Other Organization Name | SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM |
| Practice Address |
5350 S Western Ave Suite 555` Oklahoma City OK 73109-4520 |
| Mailing Address |
6262 S Sheridan Rd Tulsa OK 74133-4055 |
| Practice Telephone | 4056314567 |
| Practice Fax Number | 4059962113 |
| Mailing Telephone | 9184928200 |
| Mailing Fax Number | 9184933268 |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | SHARON WORSHAM (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 9184928200 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
OK | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Shadow Mountain Behavioral Health System | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841304250 | Shadow Mountain Behavioral Health System, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 2801 Venture Dr, Norman, OK 73069-8215 | 2006-08-19 |
| 1982005971 | Shadow Mountain Behavioral Health System, LLC | Psychiatric Hospital | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2014-09-09 |
| 1902224801 | Shadow Mountain Behavioral Health System, LLC | Psychiatric Hospital | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2014-03-29 |
| 1184941148 | Shadow Mountain Behavioral Health System, LLC | Psychiatric Residential Treatment Facility | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2010-04-29 |
| 1528383841 | Shadow Mountain Behavioral Health System, LLC | Pharmacy | 1027 E 66th Pl, Tulsa, OK 74136-3701 | 2010-03-30 |
| 1285867713 | Shadow Mountain Behavioral Health System, LLC | Psychiatric Residential Treatment Facility | 4012 E 35th St, Tulsa, OK 74135-4528 | 2009-09-01 |
| 1831304351 | Shadow Mountain Behavioral Health System, LLC | Psychiatric Residential Treatment Facility | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2007-05-10 |
| 1740384049 | Shadow Mountain Behavioral Health System, LLC | Clinic/Center | 6125 S Sheridan Rd, Suite D, Tulsa, OK 74133-4056 | 2006-09-08 |
| 1659475952 | Shadow Mountain Behavioral Health System, LLC | Clinic/Center | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2006-09-08 |
| 1003923442 | Shadow Mountain Behavioral Health System, LLC | Psychiatric Residential Treatment Facility | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2006-08-23 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oklahoma Business Registrations | SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, LLC | 367 S. Gulph Road, King of Prussia, PA 19406 |
| Street Address |
5350 S WESTERN AVE SUITE 555` |
| City | OKLAHOMA CITY |
| State | OK |
| Zip Code | 73109-4520 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225677644 | Kyle William Ray Vail | Case Management | 5350 S Western Ave, Oklahoma City, OK 73109-4520 | 2020-01-02 |
| 1427692011 | Lauren E Massad | Counselor | 5350 S Western Ave, Oklahoma City, OK 73109-4520 | 2019-11-06 |
| 1972073062 | Courtney M Bolt | Counselor | 5350 S Western Ave, Oklahoma City, OK 73109-4520 | 2018-11-30 |
| 1821591983 | Courtney Michele Folsom | Counselor | 5350 S Western Ave, Oklahoma City, OK 73109-4520 | 2018-03-15 |
| 1235672486 | Chelsea Ricky | Counselor | 5350 S Western Ave, Oklahoma City, OK 73109 | 2016-11-21 |
| 1144776261 | Heather Covarrubia | Speech-Language Pathologist | 5350 S Western Ave, Suite 131, Oklahoma City, OK 73109-4520 | 2016-08-29 |
| 1457701583 | Amy Woodruff | Speech-Language Pathologist | 5350 S Western Ave, Suite 525, Oklahoma City, OK 73109-4520 | 2016-06-20 |
| 1053766634 | Caitlin Taylor Ulrich | Speech-Language Pathologist | 5350 S Western Ave, #525, Oklahoma City, OK 73109-4520 | 2016-05-02 |
| 1538523865 | Kristina Angelica Dominguez | Speech-Language Pathologist | 5350 S Western Ave, 525, Oklahoma City, OK 73109-4520 | 2016-04-12 |
| 1376906800 | Bilingual Pediatric Therapies, Inc. | Clinic/Center | 5350 S Western Ave, Suite #525, Oklahoma City, OK 73109-4520 | 2016-04-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063905354 | Housecalls | Family Medicine | 4413 S Lee Ave, Oklahoma City, OK 73109 | 2018-06-11 |
| 1225559404 | John Nathan Jacobsen | Dentist | 235 Sw 25th St., Oklahoma City, OK 73109 | 2017-06-28 |
| 1659828648 | Cynthia Jane Laney | Registered Nurse | 4401 South Western, Oklahoma City, OK 73109 | 2016-09-07 |
| 1497104780 | Hazel Soto | Case Manager/Care Coordinator | 420 Sw, St, Oklahoma, OK 73109 | 2016-06-07 |
| 1063873677 | Ardeceley Brandi Annette Hernandez | Community/Behavioral Health | 5714 S. Western Ave, Oklahoma City, OK 73109 | 2016-03-09 |
| 1316343908 | Van Ngo | Nurse Practitioner | 4413 South Lee Ave, Oklahoma City, OK 73109 | 2014-11-10 |
| 1104249150 | Janessa Ladawn Bointy | Counselor | 5359 S. Western Ave. #707, Oklahoma City, OK 73109 | 2014-01-28 |
| 1033540299 | Bryan Graham | Case Manager/Care Coordinator | 1111 Sw 28th St, Oklahoma City, OK 73109 | 2013-12-12 |
| 1154684603 | Nubia Fiesel | Counselor | 420 Sw 10th Street, Oklahoma City, OK 73109 | 2012-06-20 |
| 1548533664 | C.c. Freeman, Md. Inc | Internal Medicine | 4221 S. Western Ave., Suite 2015, Oklahoma City, OK 73109 | 2012-02-21 |
| Find all providers in zip 73109 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306455068 | Restore Family Counseling, LLC | Clinic/Center | 100 W. Wilshire, Suite #c3, Oklahoma City, OK 73116 | 2020-07-29 |
| 1508480872 | Maria Nancy Martinez | Clinic/Center | 5350 S Western Ave Ste 217, Oklahoma City, OK 73109-4525 | 2020-06-03 |
| 1144842923 | Forth Star Counseling LLC | Clinic/Center | 5350 S Western Ave Ste 731, Oklahoma City, OK 73109-4520 | 2020-05-14 |
| 1366082315 | Nourished | Clinic/Center | 10400 Vineyard Blvd Ste B, Oklahoma City, OK 73120-3830 | 2020-01-07 |
| 1750947487 | Counseling and Mediation Services of Oklahoma | Clinic/Center | 13909 Technology Dr, Oklahoma City, OK 73134-1056 | 2019-05-17 |
| 1801366554 | Divine Holistic Intervention Services LLC. | Clinic/Center | 1330 N Classen Blvd Ste 310, Oklahoma City, OK 73106-6834 | 2018-11-26 |
| 1518436518 | Total Care Behavioral Health Services, LLC | Clinic/Center | 5350 S Western Ave Ste 548, Oklahoma City, OK 73109-4536 | 2018-11-19 |
| 1780176479 | Penny Lane Therapy LLC | Clinic/Center | 4416 N Western Ave Ste 207, Oklahoma City, OK 73118-5256 | 2018-05-30 |
| 1134619646 | Anthony Sean Buckley | Clinic/Center | 8018 Nw 87th St, Oklahoma City, OK 73132-3229 | 2018-05-10 |
| 1801396924 | Higher Purpose Counseling Center LLC | Clinic/Center | 6444 Nw Expressway Ste 425d, Oklahoma City, OK 73132-8125 | 2018-02-15 |
| Find all providers in OKLAHOMA CITY | ||||
| City | OKLAHOMA CITY |
| Zip Code | 73109 |
Please comment or provide details below to improve the information on SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, LLC.
| 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.