Provider Demographics
NPI:1538535174
Name:MYRICK, TRACY K
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:K
Last Name:MYRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9571 COUNTRY SIDE LN
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-1914
Mailing Address - Country:US
Mailing Address - Phone:405-436-9917
Mailing Address - Fax:
Practice Address - Street 1:6501 BROADWAY EXT
Practice Address - Street 2:SUITE 180
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-8239
Practice Address - Country:US
Practice Address - Phone:405-607-4041
Practice Address - Fax:405-463-0090
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22675101YM0800X
OK06711101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health