Provider Demographics
NPI:1568823771
Name:MYERS, KAYLYN
Entity Type:Individual
Prefix:
First Name:KAYLYN
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-2756
Mailing Address - Country:US
Mailing Address - Phone:541-772-1777
Mailing Address - Fax:541-734-2410
Practice Address - Street 1:3397 DELTA WATERS RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5852
Practice Address - Country:US
Practice Address - Phone:541-772-4648
Practice Address - Fax:541-734-2410
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)