Provider Demographics
NPI:1821567843
Name:STEELE, MYRA LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:LYNN
Last Name:STEELE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MYRA
Other - Middle Name:LYNN
Other - Last Name:WOOLDRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 CONCAR DR
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2681
Mailing Address - Country:US
Mailing Address - Phone:276-979-7581
Mailing Address - Fax:276-964-0292
Practice Address - Street 1:400 CONCAR DR
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2681
Practice Address - Country:US
Practice Address - Phone:276-979-7581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007976101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional