Provider Demographics
NPI:1003039017
Name:ARCHER, DAN J (MS)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:J
Last Name:ARCHER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 E MEMORIAL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6470
Mailing Address - Country:US
Mailing Address - Phone:405-760-0242
Mailing Address - Fax:
Practice Address - Street 1:2801 E MEMORIAL RD STE 102
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6470
Practice Address - Country:US
Practice Address - Phone:405-760-0242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2176101YP2500X
OK759106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist