Provider Demographics
NPI:1508174715
Name:MYERS, NICOLE L (BSW)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:L
Last Name:MYERS
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:IL
Mailing Address - Zip Code:62863-1945
Mailing Address - Country:US
Mailing Address - Phone:618-263-4970
Mailing Address - Fax:618-263-4837
Practice Address - Street 1:1001 N MARKET ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:IL
Practice Address - Zip Code:62863-1945
Practice Address - Country:US
Practice Address - Phone:618-263-4970
Practice Address - Fax:618-263-4837
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1508174715OtherNPI