Provider Demographics
NPI:1285909564
Name:MESSICK, ELIZABETH R (BHRS)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:MESSICK
Suffix:
Gender:F
Credentials:BHRS
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 286
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:OK
Mailing Address - Zip Code:74728-0286
Mailing Address - Country:US
Mailing Address - Phone:580-743-1548
Mailing Address - Fax:
Practice Address - Street 1:4 SE AVE A
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-4620
Practice Address - Country:US
Practice Address - Phone:580-286-5262
Practice Address - Fax:580-286-5595
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200049040WMedicaid