Provider Demographics
NPI:1407127822
Name:CYPERT, CONNIE (BHRS)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:CYPERT
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-5522
Mailing Address - Country:US
Mailing Address - Phone:918-456-9791
Mailing Address - Fax:
Practice Address - Street 1:609 CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5522
Practice Address - Country:US
Practice Address - Phone:918-456-9791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health