Provider Demographics
NPI:1295776540
Name:SCHUBERT, GERI MYLEA (LPC)
Entity type:Individual
Prefix:MRS
First Name:GERI
Middle Name:MYLEA
Last Name:SCHUBERT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:GERI
Other - Middle Name:MYLEA
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19854 COUNTY ROAD 1542
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-3153
Mailing Address - Country:US
Mailing Address - Phone:580-399-5986
Mailing Address - Fax:
Practice Address - Street 1:14592 COUNTY ROAD 1560
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-7954
Practice Address - Country:US
Practice Address - Phone:580-399-5986
Practice Address - Fax:918-388-6456
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2592101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional