Provider Demographics
NPI:1548586258
Name:WINKCOMPLECK, MYRA MICHAEL
Entity Type:Individual
Prefix:MRS
First Name:MYRA
Middle Name:MICHAEL
Last Name:WINKCOMPLECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELLI
Other - Middle Name:M
Other - Last Name:WINKCOMPLECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:101 N UNION AVE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-7067
Mailing Address - Country:US
Mailing Address - Phone:405-275-7100
Mailing Address - Fax:405-275-7105
Practice Address - Street 1:101 N UNION AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-7067
Practice Address - Country:US
Practice Address - Phone:405-275-7100
Practice Address - Fax:405-275-7105
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health