Provider Demographics
NPI:1972164960
Name:MYERS, AMANDA SHANTEL (MSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:SHANTEL
Last Name:MYERS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5183 S 369TH WEST AVE
Mailing Address - Street 2:
Mailing Address - City:MANNFORD
Mailing Address - State:OK
Mailing Address - Zip Code:74044-2655
Mailing Address - Country:US
Mailing Address - Phone:918-313-5063
Mailing Address - Fax:
Practice Address - Street 1:1920 S CINCINNATI AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-5228
Practice Address - Country:US
Practice Address - Phone:918-833-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool