Provider Demographics
NPI:1528567484
Name:MYERS, NICOLE (LMFT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 EUREKA AVE STE G4
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3368
Mailing Address - Country:US
Mailing Address - Phone:714-305-0266
Mailing Address - Fax:
Practice Address - Street 1:2319 N 45TH ST STE 109
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6958
Practice Address - Country:US
Practice Address - Phone:206-701-0266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60571001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist