Provider Demographics
NPI:1114994076
Name:MYERS, DANA M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:M
Last Name:MYERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16218 PACIFIC AVE S
Mailing Address - Street 2:STE B2
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8612
Mailing Address - Country:US
Mailing Address - Phone:253-208-0275
Mailing Address - Fax:253-548-3040
Practice Address - Street 1:16218 PACIFIC AVE S
Practice Address - Street 2:STE B2
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8612
Practice Address - Country:US
Practice Address - Phone:253-208-0275
Practice Address - Fax:253-548-3040
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2528103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB27216Medicare ID - Type Unspecified