Provider Demographics
NPI:1366507527
Name:MYERS, SANDRA J (LPCC CST)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:MYERS
Suffix:
Gender:F
Credentials:LPCC CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 CLAY RD NW
Mailing Address - Street 2:
Mailing Address - City:DELLROY
Mailing Address - State:OH
Mailing Address - Zip Code:44620-9794
Mailing Address - Country:US
Mailing Address - Phone:330-735-3296
Mailing Address - Fax:
Practice Address - Street 1:1306 CLAY RD NW
Practice Address - Street 2:
Practice Address - City:DELLROY
Practice Address - State:OH
Practice Address - Zip Code:44620-9794
Practice Address - Country:US
Practice Address - Phone:330-735-3296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 0007777101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional