Provider Demographics
NPI:1063731834
Name:ELLERBY, MISTY B (LPC CANDIDATE)
Entity type:Individual
Prefix:MS
First Name:MISTY
Middle Name:B
Last Name:ELLERBY
Suffix:
Gender:F
Credentials:LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 754
Mailing Address - Street 2:
Mailing Address - City:LANGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73050-0754
Mailing Address - Country:US
Mailing Address - Phone:405-326-6102
Mailing Address - Fax:
Practice Address - Street 1:401 S. OKLAHOMA
Practice Address - Street 2:
Practice Address - City:LANGSTON
Practice Address - State:OK
Practice Address - Zip Code:73050
Practice Address - Country:US
Practice Address - Phone:405-326-6102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health