Provider Demographics
NPI:1083046148
Name:MYERS, VICTOR E (LPC)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:E
Last Name:MYERS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 W BOISE AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-4339
Mailing Address - Country:US
Mailing Address - Phone:208-891-0318
Mailing Address - Fax:
Practice Address - Street 1:690 S INDUSTRY WAY STE 45
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7907
Practice Address - Country:US
Practice Address - Phone:208-922-2207
Practice Address - Fax:208-922-4168
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5325101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health