Provider Demographics
NPI:1467720789
Name:DANA M MYERS PSYD PLLC
Entity Type:Organization
Organization Name:DANA M MYERS PSYD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:253-208-0275
Mailing Address - Street 1:16218 PACIFIC AVE S
Mailing Address - Street 2:STE B2
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8612
Mailing Address - Country:US
Mailing Address - Phone:253-208-0275
Mailing Address - Fax:
Practice Address - Street 1:16218 PACIFIC AVE S
Practice Address - Street 2:STE B2
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8612
Practice Address - Country:US
Practice Address - Phone:253-208-0275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2528103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP51713Medicare UPIN