Provider Demographics
NPI:1073703120
Name:MYERS, GINGER COLLOPY (LMFT)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:COLLOPY
Last Name:MYERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 PINE SPRUCE LN
Mailing Address - Street 2:
Mailing Address - City:PINETOP
Mailing Address - State:AZ
Mailing Address - Zip Code:85935-7113
Mailing Address - Country:US
Mailing Address - Phone:928-297-7460
Mailing Address - Fax:
Practice Address - Street 1:728 PINE SPRUCE LN
Practice Address - Street 2:
Practice Address - City:PINETOP
Practice Address - State:AZ
Practice Address - Zip Code:85935-7113
Practice Address - Country:US
Practice Address - Phone:928-297-7460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5171106H00000X
AZ10258106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist