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NPI Code Detail

MEDICARE: TRACY K MYRICK

MEDICARE: TRACY K MYRICK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor22675AZ
2101YM0800XMental Health Counselor06711OK
3101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1538535174
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY K MYRICK
Provider Business Mailing Address
First Line : 9571 COUNTRY SIDE LN
Second Line :
City : GUTHRIE
State : OK
Zip : 73044-1914
Country : US
Telephone Number : 405-436-9917
Fax Number :
Provider Business Practice Location Address
First Line : 6501 BROADWAY EXT
Second Line : SUITE 180
City : OKLAHOMA CITY
State : OK
Zip : 73116-8239
Country : US
Telephone Number : 405-607-4041
Fax Number : 405-463-0090
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2015
Last Update Date : 06/09/2025

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Directions to “ TRACY K MYRICK ” Practice Location

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