Provider Demographics
NPI:1811021330
Name:MYERS, JOANNA LEE (MS, NCC, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:LEE
Last Name:MYERS
Suffix:
Gender:F
Credentials:MS, NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 WEST DR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-1462
Mailing Address - Country:US
Mailing Address - Phone:812-522-7838
Mailing Address - Fax:812-522-7480
Practice Address - Street 1:505 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-1929
Practice Address - Country:US
Practice Address - Phone:812-522-1909
Practice Address - Fax:812-522-1977
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000340A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000228038OtherANTHEM BC-BS PIN
IN041272OtherSIHO PIN