SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM (NPI# 1710275201) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710275201 |
| Entity Type | Organization |
| Organization Name | SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM |
| Practice Address |
1013 E 66th Pl Tulsa OK 74136-3701 |
| Practice Telephone | 9182932500 |
| Practice Fax Number | 9184922075 |
| Mailing Telephone | 9182932500 |
| Mailing Fax Number | 9184922075 |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2011-07-18 |
| Authorized Official Name | MIKE KISTLER (CEO) |
| Authorized Official Telephone | 9184928200 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 253J00000X | Foster Care Agency | 4073 | OK | Agencies |
| 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 |
1013 E 66TH PL |
| City | TULSA |
| State | OK |
| Zip Code | 74136-3701 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376860981 | Amber Newton | Counselor | 1013 E 66th Pl, Tulsa, OK 74136-3701 | 2010-04-23 |
| 1497264816 | Melissa Hines | Case Manager/Care Coordinator | 1013 E 66th Pl, Tulsa, OK 74136-3701 | 2017-09-28 |
| 1841630134 | Hjorny Skaftason | Marriage & Family Therapist | 1013 E 66th Pl, Tulsa, OK 74136-3701 | 2013-07-01 |
| 1144668294 | Melisha Kanish Fultz | Counselor | 1013 E 66th Pl, Tulsa, OK 74136-3701 | 2013-06-11 |
| 1588932396 | Christina Marie Pizinger | Physician Assistant | 1013 E 66th Pl, Tulsa, OK 74136-3701 | 2011-12-07 |
| 1114202033 | Janet Obrien | Counselor | 1013 E 66th Pl, Tulsa, OK 74136-3701 | 2011-10-12 |
| 1356624647 | Teresa Brown | Social Worker | 1013 E 66th Pl, Tulsa, OK 74136-3701 | 2011-09-22 |
| 1366725855 | Ann R Hurst | Social Worker | 1013 E 66th Pl, Tulsa, OK 74136-3701 | 2011-09-21 |
| 1497048375 | Ryanne Mccook | Counselor | 1013 E 66th Pl, Tulsa, OK 74136-3701 | 2011-05-25 |
| 1013225762 | Crystal Lee Downs | Counselor | 1013 E 66th Pl, Tulsa, OK 74136-3701 | 2010-09-15 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912520883 | Esmeralda Rosales | Behavior Technician | 7306 S. Yale Ave, Tulsa, OK 74136 | 2020-05-26 |
| 1851939631 | Kenneth Aaron Pohl | Behavior Technician | 7107 S. Braden Ave. Suite 195, Tulsa, OK 74136 | 2019-12-12 |
| 1578109195 | Brett Ray Weaver | Chiropractor | Kelly Bldg Ste 106, 6565 S Yale Ave, Tulsa, OK 74136 | 2019-11-19 |
| 1477194488 | Adhd and Mood Center of Oklahoma | Clinic/Center | 6565 South Yale Ave, Suite 706, Tulsa, OK 74136 | 2019-10-01 |
| 1093272510 | Whitney Christine Pilkenton | Registered Nurse | 6161 S. Yale Ave., Tulsa, OK 74136 | 2019-02-21 |
| 1538639190 | Osu Center for Health Sciences | Clinic/Center | 6465 S. Yale Ave. Suite 514, Tulsa, OK 74136 | 2018-11-27 |
| 1043786304 | Saint Francis Hospital, Inc. | Hospice Care, Community Based | 6600 South Yale Ave Suite 350, Tulsa, OK 74136 | 2018-10-15 |
| 1891282877 | Premier Rheumatology of Oklahoma | Internal Medicine | 6114 E. 61st Street, Tulsa, OK 74136 | 2018-04-16 |
| 1679092175 | Grace Eloise Evans | Counselor | 6655 S. Yale Ave, Tulsa, OK 74136 | 2017-09-15 |
| 1598283756 | David Oladipo Abioye | Counselor | 7110 S Utica Avenue, Suite 613, Tulsa, OK 74136 | 2017-09-07 |
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| Taxonomy Code | 253J00000X |
| Grouping | Agencies |
| Classification | Foster Care Agency |
| A Foster Care Agency is an agency that provides foster care as defined in the Code of Federal Regulations (CFR) as "24-hour substitute care for children outside their own homes." Foster care settings include, but are not limited to, nonrelative foster family homes, relative foster homes (whether payments are being made or not), group homes, emergency shelters, residential facilities, and pre-adoptive homes. |
| Notes: Source: Code Of Federal Regulations, Title 45, Volume 4, Part 1355, Section 57 [1/1/2008: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043603376 | Arrow Child and Family Ministries of Oklahoma | Foster Care Agency | 7710 Nw 10th St, Oklahoma City, OK 73127-4413 | 2015-03-11 |
| 1740618305 | Good Samaritan Foster Care LLC | Foster Care Agency | 545 W Strothers Ave, Seminole, OK 74868-3126 | 2013-10-17 |
| 1073823431 | Melba Jo Atkinson | Foster Care Agency | 4777 110th. St., Byars, OK 74831 | 2010-10-19 |
| 1639400484 | James Kenneth Clemons | Foster Care Agency | 2725 Ne Euclid Ave, Lawton, OK 73507-7147 | 2010-01-19 |
| 1740826999 | Oklahoma Families First Inc | Foster Care Agency | 2227 W Lindsey St Ste 1550, Norman, OK 73069-4075 | 2019-11-22 |
| 1245780592 | Regina Shumate | Foster Care Agency | 904 Nw 4th St, Stigler, OK 74462-1653 | 2016-10-11 |
| 1073067344 | Melissa Reading | Foster Care Agency | 904 Nw 4th St, Stigler, OK 74462-1653 | 2016-08-04 |
| 1255789178 | Addison Bailie Mcconnell | Foster Care Agency | 904 Nw 4th St, Stigler, OK 74462-1653 | 2016-06-01 |
| 1407211444 | Choices for Life Foster Care Inc. | Foster Care Agency | 4101 Perimeter Center Dr, Suite 250, Oklahoma City, OK 73112-2302 | 2015-12-17 |
| 1669809745 | Yco West, Inc Tfc | Foster Care Agency | 222 E Sheridan Ave, Suite 2, Oklahoma City, OK 73104-4233 | 2013-10-03 |
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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.