Provider Demographics
NPI:1851503569
Name:TERRY, MYRNA JOY (CM-A,BHRS)
Entity Type:Individual
Prefix:MS
First Name:MYRNA
Middle Name:JOY
Last Name:TERRY
Suffix:
Gender:F
Credentials:CM-A,BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4436 NW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2212
Mailing Address - Country:US
Mailing Address - Phone:405-810-9578
Mailing Address - Fax:405-810-9597
Practice Address - Street 1:2512 S HARVEY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-5958
Practice Address - Country:US
Practice Address - Phone:405-810-9578
Practice Address - Fax:405-810-9597
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK73-1134098Medicaid