Provider Demographics
NPI:1497910863
Name:MYERS, WESLEY MICHAEL (PSYD)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:MICHAEL
Last Name:MYERS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-3325
Mailing Address - Country:US
Mailing Address - Phone:610-275-1401
Mailing Address - Fax:610-539-7687
Practice Address - Street 1:1 S MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403-3325
Practice Address - Country:US
Practice Address - Phone:610-275-1401
Practice Address - Fax:610-539-7687
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002749101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional