Healthcare Provider Details

I. General information

NPI: 1649756388
Provider Name (Legal Business Name): MISHELLE DYER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W MAIN ST STE 140
ARDMORE OK
73401-6321
US

IV. Provider business mailing address

333 W MAIN ST STE 140
ARDMORE OK
73401-6321
US

V. Phone/Fax

Practice location:
  • Phone: 580-402-0298
  • Fax:
Mailing address:
  • Phone: 580-402-0298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: