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Deactivated NPI 1013930593 Deactivated / Inactive NPI Male Practitioner

Billy Jack

Counselor - Addiction (Substance Use Disorder) • Ada, OK

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Billy Jack has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date July 25, 2006
NPI Deactivation Date July 17, 2020
Total Practice Duration ~14 Years of Practice (2006 – 2020)

Professional Overview & Biography Verified Profile Summary

Billy Jack was a registered Counselor - Addiction (Substance Use Disorder) practicing in Ada, OK. Throughout an active medical career spanning 14 years, Billy Jack provided care at the practice location at 1001 N COUNTRY CLUB RD until profile deactivation on 2020-07-17.

Practice Location & Contact Primary Location

Practice Address

1001 N Country Club Rd

Ada, OK 748202847

Telephone 5804214570
Fax 5804216283
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Counselor - Addiction (Substance Use Disorder) in Ada, OK

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 12.7 Yrs
Regional Practice Density
34 Specialists

Practicing in Ada, OK (1474 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Counselor - Addiction (Substance Use Disorder) Primary Specialty

NUCC Taxonomy Code: 101YA0400X

State License OK 248

Definition to come...

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
NPI 1003170887

Doctor of Dental Surgery

Dr. Lucretia Barker , MD

Obstetrics & Gynecology

NPI 1003817172

Doctor of Medicine (M.D.)

Tanya Hatter

Pharmacy Technician

NPI 1013088616
Dr. Olivia Reed , DO

Emergency Medicine

NPI 1013380021

Doctor of Osteopathic Medicine (D.O.)

Clay Warren

Physical Medicine & Rehabilitation

NPI 1023198165
Wesley Cox

Pharmacist

NPI 1023198942

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated July 17, 2020

Record deactivated on July 17, 2020

NPI Profile Active July 23, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 23, 2007

Registered at 1001 N COUNTRY CLUB RD, ADA, OK 748202847 (Tel: 5804214570)

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Updated Business Mailing Address July 23, 2007

Registered at 1001 N COUNTRY CLUB RD, ADA, OK 748202847 (Tel: 5804214570)

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Provider Name / Credentials Updated July 23, 2007

Recorded as BILLY JACK

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 23, 2007

Counselor (License #248 in OK)

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Initial NPI Registration & Enumeration July 25, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1013930593
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 25, 2006
Last Update: July 23, 2007
Deactivation Date: July 17, 2020

Mailing Address

1001 N Country Club Rd

Ada, OK 748202847

Phone: 5804214570

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.