Provider Demographics
NPI:1417259177
Name:MYERS, KRYSTAL N
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:N
Last Name:MYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 BELHAVEN FALLS DR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3360
Mailing Address - Country:US
Mailing Address - Phone:407-719-2827
Mailing Address - Fax:
Practice Address - Street 1:548 BELHAVEN FALLS DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3360
Practice Address - Country:US
Practice Address - Phone:407-719-2827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor