Provider Demographics
NPI:1275665721
Name:MYERS COUNSELING GROUP, LTD
Entity Type:Organization
Organization Name:MYERS COUNSELING GROUP, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW,CADC
Authorized Official - Phone:815-308-3368
Mailing Address - Street 1:300 MEMORIAL DR STE 200
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6273
Mailing Address - Country:US
Mailing Address - Phone:815-308-3368
Mailing Address - Fax:815-356-7044
Practice Address - Street 1:300 MEMORIAL DR STE 200
Practice Address - Street 2:SUITE 208
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6273
Practice Address - Country:US
Practice Address - Phone:815-308-3368
Practice Address - Fax:815-356-7044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-11
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty