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General NPI Number Information
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NPI Number | 1235227588
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Entity Type | Organization
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Legal Business Name | NOVA THERAPY WORKS, P.L.L.C.
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 207 2ND AVE SW
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City | MIAMI
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State | OK
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Zip | 74354-6818
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Country | US
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Telephone | 918-540-7458
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Fax | 918-540-7455
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Provider Business Mailing Address
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Address Line | PO BOX 931
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City | MIAMI
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State | OK
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Zip | 74355-0931
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Country | US
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Telephone | 918-540-7458
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Fax | 918-540-7745
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACK DOUGLAS MYERS JR.
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Credential | PH.D.
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Telephone | 918-540-7458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1025
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License Number State | OK
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