Provider Demographics
NPI:1083952766
Name:DYER, MICHAEL RAY
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RAY
Last Name:DYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 W WILSHIRE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7754
Mailing Address - Country:US
Mailing Address - Phone:405-286-3900
Mailing Address - Fax:
Practice Address - Street 1:245 W WILSHIRE BLVD STE A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7754
Practice Address - Country:US
Practice Address - Phone:405-286-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health