Provider Demographics
NPI:1548747322
Name:MYERS, OKSANA HAUK (LP)
Entity Type:Individual
Prefix:MS
First Name:OKSANA
Middle Name:HAUK
Last Name:MYERS
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 662
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-0662
Mailing Address - Country:US
Mailing Address - Phone:217-220-4110
Mailing Address - Fax:
Practice Address - Street 1:70 BENCHMARK RD
Practice Address - Street 2:SUITE 202
Practice Address - City:AVON
Practice Address - State:CO
Practice Address - Zip Code:81631
Practice Address - Country:US
Practice Address - Phone:970-279-3463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0109648101YP2500X
NY001025102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty