1396106092 NPI number — KARA D MYERS LCSW LLC

Table of content: (NPI 1396106092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396106092 NPI number — KARA D MYERS LCSW LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KARA D MYERS LCSW LLC
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:
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:
1396106092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
511 E 12TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97401-3608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-514-0393
Provider Business Mailing Address Fax Number:
541-344-7595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 E 12TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97401-3608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-514-0393
Provider Business Practice Location Address Fax Number:
541-344-7595
Provider Enumeration Date:
03/09/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MYERS
Authorized Official First Name:
KARA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
SOLE OWNER/MEMBER
Authorized Official Telephone Number:
541-514-0393

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  L4887 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 500642282 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com