Healthcare Provider Details

I. General information

NPI: 1245331925
Provider Name (Legal Business Name): GLYN ANDREW BYTE L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 02/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S 7TH ST
CHICKASHA OK
73018-3301
US

IV. Provider business mailing address

884 BLACK JACK CT
BLANCHARD OK
73010-6607
US

V. Phone/Fax

Practice location:
  • Phone: 405-222-4786
  • Fax: 405-222-1615
Mailing address:
  • Phone: 405-222-4786
  • Fax: 405-222-1615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2456
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: