Individual
MIRISSA JOY BEAVERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4400 N LINCOLN BLVD, OKLAHOMA CITY, OK 73105-5104
(405) 638-0961
Mailing address
3457 ROBIN DR, WOODWARD, OK 73801-3941
(580) 216-4170
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
8848
OK
Other
Enumeration date
11/25/2019
Last updated
04/02/2025
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