Provider Demographics
NPI:1457479933
Name:EGGERT, MYRA M
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:M
Last Name:EGGERT
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 1:5707 N 22ND STREET
Mailing Address - Street 2:MENTAL HEALTH CARE INC
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610
Mailing Address - Country:US
Mailing Address - Phone:813-272-2878
Mailing Address - Fax:813-272-3766
Practice Address - Street 1:5707 N 22ND STREET
Practice Address - Street 2:MENTAL HEALTH CARE INC
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610
Practice Address - Country:US
Practice Address - Phone:813-272-2878
Practice Address - Fax:813-272-3766
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3493101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health