Provider Demographics
NPI:1861718702
Name:MYLES-NIXON, CHAROLETTE ANN (PHD)
Entity type:Individual
Prefix:PROF
First Name:CHAROLETTE
Middle Name:ANN
Last Name:MYLES-NIXON
Suffix:
Gender:F
Credentials:PHD
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 60004
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73146-0004
Mailing Address - Country:US
Mailing Address - Phone:405-708-2689
Mailing Address - Fax:
Practice Address - Street 1:2231 NW 16TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-4926
Practice Address - Country:US
Practice Address - Phone:405-708-2689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK115677103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool