Provider Demographics
NPI:1720005473
Name:SLOAT, MYRON CONRAD JR (LPC)
Entity Type:Individual
Prefix:MR
First Name:MYRON
Middle Name:CONRAD
Last Name:SLOAT
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16617 DALMAHOY DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-5514
Mailing Address - Country:US
Mailing Address - Phone:512-773-3236
Mailing Address - Fax:
Practice Address - Street 1:1100 ROUND ROCK AVE
Practice Address - Street 2:STE 107B
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4511
Practice Address - Country:US
Practice Address - Phone:512-773-3236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16785101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional