Provider Demographics
NPI:1164431649
Name:BYERS, JACQULYN BROOKE (MS LPC)
Entity Type:Individual
Prefix:MRS
First Name:JACQULYN
Middle Name:BROOKE
Last Name:BYERS
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2532
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73402-2532
Mailing Address - Country:US
Mailing Address - Phone:580-220-1052
Mailing Address - Fax:580-226-9395
Practice Address - Street 1:333 W MAIN ST
Practice Address - Street 2:SUITE 290
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-6326
Practice Address - Country:US
Practice Address - Phone:580-220-1052
Practice Address - Fax:580-226-9395
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2894101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional