MEDICARE: MR. DAN BOB MYERS LPC

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
1	101YP2500X	Professional Counselor	2248	OK

General Provider Information

NPI Number	:	1891497608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAN BOB MYERS LPC

Provider Business Mailing Address
First Line	:	4471 COUNTY STREET 2839
Second Line	:
City	:	RUSH SPRINGS
State	:	OK
Zip	:	73082-3099
Country	:	US
Telephone Number	:	580-656-7848
Fax Number	:

Provider Business Practice Location Address
First Line	:	4471 COUNTY STREET 2839
Second Line	:
City	:	RUSH SPRINGS
State	:	OK
Zip	:	73082-3099
Country	:	US
Telephone Number	:	580-656-7848
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2023
Last Update Date	:	03/17/2023

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