1780178012 NPI number — MRS. CHERYL LEE MYERS L.C.S.W.

Table of content: MRS. CHERYL LEE MYERS L.C.S.W. (NPI 1780178012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780178012 NPI number — MRS. CHERYL LEE MYERS L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MYERS
Provider First Name:
CHERYL
Provider Middle Name:
LEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MYERS
Provider Other First Name:
CHERYL
Provider Other Middle Name:
TURZANSKI
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.C.S.W.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1780178012
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41025 THOMAS BOAT LANDING ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UMATILLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-669-1012
Provider Business Mailing Address Fax Number:
352-669-5554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41025 THOMAS BOAT LANDING ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UMATILLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-669-1012
Provider Business Practice Location Address Fax Number:
352-669-5554
Provider Enumeration Date:
06/20/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW3133 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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