NPI 1902795255 · live from the CMS NPI Registry
Affect Provider Group, P.S.C.
Counselor, Mental Health in Edmond, OK. National Provider Identifier 1902795255, active.
NPI record
| NPI | 1902795255 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Counselor, Mental Health 101YM0800X |
| Practice location | 3209 S Broadway Ste 229, Edmond, OK 73013 |
| Practice phone | 845-769-8758 |
| Mailing address | 1640 Boro Pl Fl 4, Mc Lean, VA 22102 |
| Enumerated | July 1, 2025 |
| Last updated | July 1, 2025 |
| Authorized official | Karla Mullings, Director Of Compliance |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychologist | 103T00000X | — |
| Registered Nurse, Psych/Mental Health, Adult | 163WP0809X | — |
| Psychologist, Clinical | 103TC0700X | — |
| Social Worker | 104100000X | — |
| Nurse Practitioner, Psych/Mental Health | 363LP0808X | — |
| Clinical Nurse Specialist, Psych/Mental Health | 364SP0808X | — |
| Counselor, Mental Health primary | 101YM0800X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.