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General NPI Number Information
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NPI Number | 1942403019
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Entity Type | Organization
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Legal Business Name | LISA MYERS BLACK, PH.D., PLLC
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 4003 24TH AVE NE
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City | NORMAN
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State | OK
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Zip | 73071-7749
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Country | US
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Telephone | 405-573-4019
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Fax | 405-573-4074
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Provider Business Mailing Address
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Address Line | 4003 24TH AVE NE
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City | NORMAN
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State | OK
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Zip | 73071-7749
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Country | US
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Telephone | 405-573-4019
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Fax | 405-573-4074
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Authorized Official
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Title or Position | HEALTH SERVICE PSYCHOLOGIST
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Name | DR. LISA MYERS BLACK
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Credential | PH.D.
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Telephone | 405-573-4019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 1038
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License Number State | OK
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