Provider Demographics
NPI:1275297954
Name:MYERS, DEIRDRE (MA, LLPC, NCC)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:MA, LLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N WATER ST STE 138
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2807
Mailing Address - Country:US
Mailing Address - Phone:989-402-5367
Mailing Address - Fax:
Practice Address - Street 1:215 N WATER ST STE 138
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2807
Practice Address - Country:US
Practice Address - Phone:989-402-5367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MI6451022944101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator