Healthcare Provider Details

I. General information

NPI: 1295776540
Provider Name (Legal Business Name): GERI MYLEA SCHUBERT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GERI MYLEA FERGUSON

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14592 COUNTY ROAD 1560
ADA OK
74820-7954
US

IV. Provider business mailing address

19854 COUNTY ROAD 1542
ADA OK
74820-3153
US

V. Phone/Fax

Practice location:
  • Phone: 580-399-5986
  • Fax: 918-388-6456
Mailing address:
  • Phone: 580-399-5986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2592
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: