Provider Demographics
NPI:1235227588
Name:NOVA THERAPY WORKS, P.L.L.C.
Entity Type:Organization
Organization Name:NOVA THERAPY WORKS, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:918-540-7458
Mailing Address - Street 1:PO BOX 931
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74355-0931
Mailing Address - Country:US
Mailing Address - Phone:918-540-7458
Mailing Address - Fax:918-540-7745
Practice Address - Street 1:207 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6818
Practice Address - Country:US
Practice Address - Phone:918-540-7458
Practice Address - Fax:918-540-7455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1025103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty