Provider Demographics
NPI:1467536193
Name:MYERS, JOSHUA GARY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:GARY
Last Name:MYERS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7768 WOODLAND BEND CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-5634
Mailing Address - Country:US
Mailing Address - Phone:239-561-9955
Mailing Address - Fax:239-561-9779
Practice Address - Street 1:6150 DIAMOND CENTRE CT
Practice Address - Street 2:SUITE 1003
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4365
Practice Address - Country:US
Practice Address - Phone:239-561-9955
Practice Address - Fax:239-561-9779
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6395103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical