Provider Demographics
NPI:1164475349
Name:MYERS, JENNIFER M (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:MYERS
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3814 WOODMERE CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-4127
Mailing Address - Country:US
Mailing Address - Phone:812-327-8846
Mailing Address - Fax:
Practice Address - Street 1:120 W 7TH ST
Practice Address - Street 2:SUITE 312
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3834
Practice Address - Country:US
Practice Address - Phone:812-334-2500
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001659A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health