Provider Demographics
NPI:1942320395
Name:BIERNE, ROMA JANICE (LPC)
Entity Type:Individual
Prefix:MS
First Name:ROMA
Middle Name:JANICE
Last Name:BIERNE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:
Other - Last Name:BIERNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:2912 S DOUGLAS BLVD
Mailing Address - Street 2:STE. A
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-7179
Mailing Address - Country:US
Mailing Address - Phone:405-737-1132
Mailing Address - Fax:405-721-0646
Practice Address - Street 1:2912 S DOUGLAS BLVD
Practice Address - Street 2:STE. A
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-7179
Practice Address - Country:US
Practice Address - Phone:405-737-1132
Practice Address - Fax:405-721-0646
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1288101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
246144OtherTRICARE