PRODIGY FOUNDATION (NPI# 1386665743) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386665743 |
| Entity Type | Organization |
| Organization Name | PRODIGY FOUNDATION |
| Practice Address |
1024 S Muskogee Ave Tahlequah OK 74464-4734 |
| Mailing Address |
Po Box 1247 Tahlequah OK 74465-1247 |
| Practice Telephone | 9184568399 |
| Practice Fax Number | 9184568773 |
| Mailing Telephone | 9184568399 |
| Mailing Fax Number | 9184568773 |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | SUSAN HOPE ROBERTS (DIRECTOR) |
| Authorized Official Telephone | 9184568399 |
| Authorized Official Credential | LPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| X | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| X | 101YP2500X |
Counselor Specialization: Professional |
Behavioral Health & Social Service Providers | ||
| X | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700928603 | Prodigy Foundation | Community/Behavioral Health | 1024 S Muskogee Ave, Tahlequah, OK 74464-4734 | 2007-02-14 |
| Street Address |
1024 S MUSKOGEE AVE |
| City | TAHLEQUAH |
| State | OK |
| Zip Code | 74464-4734 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700928603 | Prodigy Foundation | Community/Behavioral Health | 1024 S Muskogee Ave, Tahlequah, OK 74464-4734 | 2007-02-14 |
| 1679619985 | Teresa L. Borremans | Registered Nurse | 1024 S Muskogee Ave, Tahlequah, OK 74464-4734 | 2007-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184253403 | Kendall Harris | Student in an Organized Health Care Education/Training Program | 100 Bliss Ave, Tahlequah, OK 74464 | 2020-04-07 |
| 1528609302 | Norma Brightly | Technician | 103 Sequoyah, Tahlequah, OK 74464 | 2019-10-03 |
| 1073175832 | Jody Lynn Dallis | Case Manager/Care Coordinator | Tenkiller Behavioral Services, 27753 S. Welling Rd, Welling, OK 74464 | 2019-07-02 |
| 1184287849 | Perry Jake Proctor | Student in an Organized Health Care Education/Training Program | 1400 E Downing St, Tahlequah, Ok 74464, Tahlequah, OK 74464 | 2019-04-18 |
| 1336657279 | Sidney Sheyenne Kimble | Case Manager/Care Coordinator | 1429 Jack Brown Lane, Tahlequah, OK 74464 | 2018-01-12 |
| 1891225686 | Nichols Bradley Alberty | Orthotist | 1294 East Downing, Suite 3, Tahlequah, OK 74464 | 2017-06-14 |
| 1922549690 | Krystal Easter Ms, Lpc | Counselor | 2201 Oakridge Dr, Tahlequah, OK 74464 | 2017-03-15 |
| 1144777319 | Northeastern Oklahoma Community Health Centers, Inc. | Clinic/Center | 529 N. Oak St., Tahlequah, OK 74464 | 2016-09-06 |
| 1548713456 | Clement Isioma Nwadozi | Optometrist | 3763 Southridge Cir Apt 6, Tahlequah, OK 74464 | 2016-07-27 |
| 1033532635 | Wesley Gragg | Specialist/Technologist | 603 North Grand Avenue, Tahlequah, OK 74464 | 2014-02-03 |
| Find all providers in zip 74464 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679105068 | Audrey June Halfacre | Counselor | 4803 Ridge St, Tahlequah, OK 74464-5644 | 2020-02-04 |
| 1194008698 | Kerby Behavioral Development, Pllc | Counselor | 402 Janet St, Tahlequah, OK 74464-7028 | 2011-09-21 |
| 1376847087 | Dana Freeman | Counselor | 1276 S. Muskogee Ave., Tahlequah, OK 74464 | 2011-01-10 |
| 1811291586 | Ben B Barnett | Counselor | 17091 S. Muskogee Ave., Tahlequah, OK 74464 | 2011-01-10 |
| 1124338272 | Kathy Hampton-swaffar | Counselor | 1200 W 4th St Ste D, Tahlequah, OK 74464-5013 | 2010-10-07 |
| 1316253586 | Sadie Terecy Blum | Counselor | 1 Plaza South St, Tahlequah, OK 74464-4750 | 2010-08-26 |
| 1316198666 | Kendall D Dean | Counselor | 108 N Lena Ave, Tahlequah, OK 74464-3327 | 2008-10-06 |
| 1386801942 | Levi Taylor Keehler | Counselor | 2063 Mahaney Ave, Tahlequah, OK 74464-5731 | 2008-05-21 |
| 1255501144 | Callie Ann Hathcoat | Counselor | 720 College Ct, Tahlequah, OK 74464-4741 | 2008-03-06 |
| 1700076387 | Cora L. Eckenberger | Counselor | 1910 S Muskogee Ave, Tahlequah, OK 74464-5437 | 2007-07-30 |
| Find all providers in TAHLEQUAH | ||||
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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.