Provider Demographics
NPI:1891089512
Name:MYERS, TRICIA (MS)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, LADC
Mailing Address - Street 1:1200 NW 34TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-5615
Mailing Address - Country:US
Mailing Address - Phone:405-229-4439
Mailing Address - Fax:
Practice Address - Street 1:6612 NW 42ND ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-2764
Practice Address - Country:US
Practice Address - Phone:405-693-6902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5166101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health