Provider Demographics
NPI:1376780221
Name:MYERS, JENNIFER (PHD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 COOMBS FARM RD
Mailing Address - Street 2:BLDG D UNIT 012
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1124
Mailing Address - Country:US
Mailing Address - Phone:304-241-1766
Mailing Address - Fax:304-381-2648
Practice Address - Street 1:4000 COOMBS FARM RD
Practice Address - Street 2:BLDG D UNIT 012
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1124
Practice Address - Country:US
Practice Address - Phone:304-241-1766
Practice Address - Fax:304-381-2648
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV926103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical