Provider Demographics
NPI:1891067211
Name:DINA MYERS LPPC
Entity Type:Organization
Organization Name:DINA MYERS LPPC
Other - Org Name:DINA MILUM PHD, LPC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MILUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:928-600-2148
Mailing Address - Street 1:7509 MOONBEAM DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-3147
Mailing Address - Country:US
Mailing Address - Phone:928-600-2148
Mailing Address - Fax:888-839-9660
Practice Address - Street 1:930 N SWITZER CANYON DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4824
Practice Address - Country:US
Practice Address - Phone:928-600-2148
Practice Address - Fax:888-839-9660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-11859251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health