Healthcare Provider Details

I. General information

NPI: 1235227588
Provider Name (Legal Business Name): NOVA THERAPY WORKS, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 2ND AVE SW
MIAMI OK
74354-6818
US

IV. Provider business mailing address

PO BOX 931
MIAMI OK
74355-0931
US

V. Phone/Fax

Practice location:
  • Phone: 918-540-7458
  • Fax: 918-540-7455
Mailing address:
  • Phone: 918-540-7458
  • Fax: 918-540-7745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1025
License Number StateOK

VIII. Authorized Official

Name: DR. JACK DOUGLAS MYERS JR.
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 918-540-7458