JACQUELINE BONTRAGER (NPI# 1245655448) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245655448 |
| Entity Type | Individual |
| Full Name | JACQUELINE BONTRAGER |
| Practice Address |
3015 E Skelly Dr Suite 103 Tulsa OK 74105-6317 |
| Mailing Address |
2312 W Quinton St Broken Arrow OK 74011-4511 |
| Practice Telephone | 9187120859 |
| Mailing Telephone | 9186152040 |
| Enumeration Date | 2014-02-25 |
| Last Update Date | 2014-02-25 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 100746170G | 05 |
| Street Address |
3015 E SKELLY DR SUITE 103 |
| City | TULSA |
| State | OK |
| Zip Code | 74105-6317 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205821022 | Manju Kaul | Psychologist | 3015 E Skelly Dr, Suite 135, Tulsa, OK 74105-6317 | 2005-09-19 |
| 1285294421 | Mary Thomas | Counselor | 3015 E Skelly Dr, Tulsa, OK 74105-6317 | 2019-06-19 |
| 1427614213 | Brittney Zickefoose | Social Worker | 3015 E Skelly Dr, Tulsa, OK 74105-6317 | 2019-05-16 |
| 1215452305 | Lorena Isamar Herrera | Case Manager/Care Coordinator | 3015 E Skelly Dr, Tulsa, OK 74105-6317 | 2017-08-09 |
| 1295269652 | Bre Campbell | Case Manager/Care Coordinator | 3015 E Skelly Dr, Suite 103, Tulsa, OK 74105-6317 | 2017-04-12 |
| 1588197719 | Brittanie Harmon | Case Manager/Care Coordinator | 3015 E Skelly Dr, Suite 103, Tulsa, OK 74105-6317 | 2017-04-05 |
| 1326570029 | Ignacio Saldana | Case Manager/Care Coordinator | 3015 E Skelly Dr, Suite 103, Tulsa, OK 74105-6317 | 2017-03-31 |
| 1790226959 | Kandice Lawson | Case Manager/Care Coordinator | 3015 E Skelly Dr, Suite 103, Tulsa, OK 74105-6317 | 2017-03-20 |
| 1942741772 | Carrie Roberts | Counselor | 3015 E Skelly Dr, Suite 103, Tulsa, OK 74105-6317 | 2017-03-13 |
| 1063950624 | Breakthrough Family Counseling Services | Community/Behavioral Health | 3015 E Skelly Dr, 211-7, Tulsa, OK 74105-6317 | 2017-02-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881208817 | Op Pharmacy LLC | Pharmacy | 2865 E. Skelly Dr., Ste 225, Tulsa, OK 74105 | 2020-09-08 |
| 1114560554 | Secure Interpretation, LLC | Neurological Surgery | 5561 South Lewis Ave, Tulsa, OK 74105 | 2019-10-17 |
| 1629547286 | Kealey Jordan Oliver | Occupational Therapist | 3223 E. 31st Steet, Tulsa, OK 74105 | 2018-11-13 |
| 1265915631 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 3516 S Peoria Ave, Tulsa, OK 74105 | 2018-09-12 |
| 1235635277 | Brenda Kay Sanders | Speech-Language Pathologist | 4911 S Detroit Ave, Tulsa, OK 74105 | 2018-03-30 |
| 1417400771 | Caroline Hunter Heineck | Speech-Language Pathologist | 3223 E. 31st St., Tulsa, OK 74105 | 2016-08-03 |
| 1437509544 | Reliance Care Health Services LLP | Home Health | 5810 S. Peoria Avenue, Tulsa, OK 74105 | 2016-06-20 |
| 1578921748 | Latisha Henderson | Case Manager/Care Coordinator | 3015 E. Skelly Drive, Suite 103, Tulsa, OK 74105 | 2016-02-03 |
| 1326424573 | Evelyn J Fennell | Nurse's Aide | 1143 E 57th Place, Tulsa, OK 74105 | 2015-08-10 |
| 1255717757 | Rebecca Ann Hughes | Dentist | 3150 E 41st St Ste 131, Tulsa, OK 74105 | 2015-08-06 |
| Find all providers in zip 74105 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851853188 | New Beginnings Counseling Agency | Community/Behavioral Health | 6216 S Lewis Ave Ste 103, Tulsa, OK 74136-1017 | 2019-04-04 |
| 1194201723 | Heart Youth & Family Therapy, Inc. | Community/Behavioral Health | 3171 S 129th East Ave # A1161, Tulsa, OK 74134-3205 | 2018-07-17 |
| 1669968665 | Amayesing Skillz LLC | Community/Behavioral Health | 1108 W Tecumseh St, Tulsa, OK 74127-2506 | 2018-07-03 |
| 1093209660 | Phelps Helps, Inc. | Community/Behavioral Health | 4870 S Lewis Ave Ste 190, Tulsa, OK 74105-5186 | 2018-06-18 |
| 1891296836 | Aws Behavioral Health | Community/Behavioral Health | 9 E 4th St Ste 602, Tulsa, OK 74103-5103 | 2018-02-26 |
| 1831603448 | Tamika Ross | Community/Behavioral Health | 9339 E 56th St, Tulsa, OK 74145-7928 | 2017-11-20 |
| 1780133827 | Connections Counseling Group Pllc | Community/Behavioral Health | 1710 S Boston Ave, Tulsa, OK 74119-4810 | 2016-09-30 |
| 1861941940 | Tulsa Mental Health and Wellness Center | Community/Behavioral Health | 5103 S Sheridan Rd, # 653, Tulsa, OK 74145-7627 | 2016-09-29 |
| 1053761080 | Stacy Mitchell | Community/Behavioral Health | 2816 E 51st St, Tulsa, OK 74105-1737 | 2016-06-21 |
| 1851751135 | Phillip A Black LLC | Community/Behavioral Health | 4815 S Harvard Ave Ste 428, Tulsa, OK 74135-3068 | 2016-03-01 |
| 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.