Provider Demographics
NPI:1689445348
Name:MYREN, ADDISON LEE (LMSW)
Entity Type:Individual
Prefix:
First Name:ADDISON
Middle Name:LEE
Last Name:MYREN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ADDISON
Other - Middle Name:LEE
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:230 GONZALO CIR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-2247
Mailing Address - Country:US
Mailing Address - Phone:870-897-2659
Mailing Address - Fax:
Practice Address - Street 1:230 GONZALO CIR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-2247
Practice Address - Country:US
Practice Address - Phone:870-897-2659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR13108-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker