Provider Demographics
NPI:1043819865
Name:LYERLY, JEANETTE NMI (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:NMI
Last Name:LYERLY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 C ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3913
Mailing Address - Country:US
Mailing Address - Phone:907-273-4047
Mailing Address - Fax:
Practice Address - Street 1:3001 C ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3913
Practice Address - Country:US
Practice Address - Phone:907-273-4047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60812104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker