MEDICARE: APPLIED MENTAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	102	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912113325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPLIED MENTAL HEALTH

Provider Business Mailing Address
First Line	:	5809 SE 88TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-6095
Country	:	US
Telephone Number	:	405-414-7178
Fax Number	:

Provider Business Practice Location Address
First Line	:	5809 SE 88TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-6095
Country	:	US
Telephone Number	:	405-414-7178
Fax Number	:

Authorized Official
Title or Position	:	CHEIF EXECUTIVE OFFICER
Name	:	JEFFREY ERIC CARTER I
Credential	:	LPC
Telephone Number	:	405-414-7178

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	08/22/2020

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Directions to “APPLIED MENTAL HEALTH ” Practice Location

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