Provider Demographics
NPI:1730794264
Name:MYERS, CASSIDY (BCBA)
Entity type:Individual
Prefix:MRS
First Name:CASSIDY
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1121 SOUTH DOUGLAS BOULEVARD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130
Mailing Address - Country:US
Mailing Address - Phone:405-582-3990
Mailing Address - Fax:405-458-8019
Practice Address - Street 1:1121 SOUTH DOUGLAS BOULEVARD
Practice Address - Street 2:SUITE A
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130
Practice Address - Country:US
Practice Address - Phone:405-582-3990
Practice Address - Fax:405-458-8019
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-21-51895103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst