Provider Demographics
NPI:1174627285
Name:MYERS, FAY L (MDIV MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:FAY
Middle Name:L
Last Name:MYERS
Suffix:
Gender:F
Credentials:MDIV MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18154 MARTIN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2653
Mailing Address - Country:US
Mailing Address - Phone:708-206-2755
Mailing Address - Fax:708-957-9588
Practice Address - Street 1:18154 MARTIN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2653
Practice Address - Country:US
Practice Address - Phone:708-206-2755
Practice Address - Fax:708-957-9588
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical