1891067211 NPI number — DINA MYERS LPPC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891067211 NPI number — DINA MYERS LPPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DINA MYERS LPPC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891067211
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7509 MOONBEAM DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLAGSTAFF
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86004-3147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-600-2148
Provider Business Mailing Address Fax Number:
888-839-9660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
930 N SWITZER CANYON DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
FLAGSTAFF
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86001-4824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-600-2148
Provider Business Practice Location Address Fax Number:
888-839-9660
Provider Enumeration Date:
02/01/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MILUM
Authorized Official First Name:
DINA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER/PSYCHOTHERAPIST
Authorized Official Telephone Number:
928-600-2148

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  LPC-11859 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)