Provider Demographics
NPI:1891497608
Name:MYERS, DAN BOB (LPC)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:BOB
Last Name:MYERS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4471 COUNTY STREET 2839
Mailing Address - Street 2:
Mailing Address - City:RUSH SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:73082-3099
Mailing Address - Country:US
Mailing Address - Phone:580-656-7848
Mailing Address - Fax:
Practice Address - Street 1:4471 COUNTY STREET 2839
Practice Address - Street 2:
Practice Address - City:RUSH SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:73082-3099
Practice Address - Country:US
Practice Address - Phone:580-656-7848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2248101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional