Provider Demographics
NPI:1558607382
Name:MYERS, JENNIFER IRENE (LMFT 97263; 01450 NV)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:IRENE
Last Name:MYERS
Suffix:
Gender:F
Credentials:LMFT 97263; 01450 NV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-0208
Mailing Address - Country:US
Mailing Address - Phone:775-885-7717
Mailing Address - Fax:775-283-0231
Practice Address - Street 1:2874 N CARSON ST STE 215
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-1682
Practice Address - Country:US
Practice Address - Phone:775-885-7717
Practice Address - Fax:775-283-0231
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97263106H00000X
NV01450106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1558607382Medicaid