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General NPI Number Information
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NPI Number | 1700404449
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Entity Type | Individual
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Provider Name | JEREMY JOHN MYERS
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Gender | Male
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Dates
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Enumeration Date | 07/09/2020
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Last Update Date | 05/10/2022
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Provider Practice Location Address
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Address Line | 23 E ROSS AVE
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City | SAPULPA
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State | OK
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Zip | 74066-6423
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Country | US
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Telephone | 918-227-2016
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Fax |
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Provider Business Mailing Address
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Address Line | 800 ELDER AVE
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City | SAND SPRINGS
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State | OK
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Zip | 74063-7424
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Country | US
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Telephone | 918-933-0972
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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