Provider Demographics
NPI:1174643563
Name:MYERS, MICHAEL B (LMHP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:MYERS
Suffix:
Gender:M
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HIGH CIR
Mailing Address - Street 2:
Mailing Address - City:UNDERWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51576-5021
Mailing Address - Country:US
Mailing Address - Phone:712-566-9454
Mailing Address - Fax:
Practice Address - Street 1:115 S 46TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-3229
Practice Address - Country:US
Practice Address - Phone:402-553-6000
Practice Address - Fax:402-553-2428
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2410101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health