Provider Demographics
NPI:1922365204
Name:DICKMEYER, ANDREW CHRISTOPHER (BLC, BA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:CHRISTOPHER
Last Name:DICKMEYER
Suffix:
Gender:M
Credentials:BLC, BA
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 142
Mailing Address - Street 2:
Mailing Address - City:RAVIA
Mailing Address - State:OK
Mailing Address - Zip Code:73455-0142
Mailing Address - Country:US
Mailing Address - Phone:307-438-2251
Mailing Address - Fax:
Practice Address - Street 1:801 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460-2351
Practice Address - Country:US
Practice Address - Phone:307-438-2251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health