COUNTRYSIDE COUNSELING, PLLC — NPI 1780235010 (Licensed & Credentialed Behavioral Health & Social Service Providers

CMS-1500 Box 24J / 33a • NPI

1780235010

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

101YP2500X (CMS E2)

Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor

Box 32 Service Location & ZIP+4

44038 45TH ST, SHAWNEE, OK, 74804-9683

✓ 9-Digit EDI 837 ZIP+4 (74804-9683)

Practice Phone & Referral Fax

(405) 481-6683

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1780235010 (COUNTRYSIDE COUNSELING, PLLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1780235010` (NPI-2 Organization / Facility)
Provider / Legal Name	COUNTRYSIDE COUNSELING, PLLC
Plain-English Specialty	Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor NUCC Code: `101YP2500X` (Counselor, Professional)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	44038 45TH ST, SHAWNEE, OK, 74804-9683
Practice Telephone / Fax	Tel: (405) 481-6683
Administrative Mailing Address	32221 REDSKIN RD, MCLOUD, OK, 74851-8174
Enumeration & Last Sync	Enumerated: 2019-09-27 \| CMS Record Updated: 2019-09-27
Authorized Official	AMY BOWEN (Owner)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

44038 45TH ST, SHAWNEE, OK, 74804-9683

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Plain-English Taxonomy & CMS Crosswalk (101YP2500X)

What Does Taxonomy Code 101YP2500X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 101YP2500X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor"

CMS-1500 Medicare Specialty Crosswalk: CMS Code E2 (Licensed Professional Counselor)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Counselor, Professional for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (COUNTRYSIDE COUNSELING, PLLC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`101YP2500X` — Counselor, Professional Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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COUNTRYSIDE COUNSELING, PLLC (NPI #1780235010)