Provider Demographics
NPI:1942256847
Name:MYERS, KATHERINE A (PSYD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:MYERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 DRYDEN RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45439
Mailing Address - Country:US
Mailing Address - Phone:937-256-5300
Mailing Address - Fax:
Practice Address - Street 1:2621 DRYDEN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45439
Practice Address - Country:US
Practice Address - Phone:937-256-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6105103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000363413OtherANTHEM PIN
11771519OtherCAQH #