Provider Demographics
NPI:1104581321
Name:MYERS, RHONDA JUNE (LEP3603)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:JUNE
Last Name:MYERS
Suffix:
Gender:F
Credentials:LEP3603
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:ARBUCKLE
Mailing Address - State:CA
Mailing Address - Zip Code:95912-0297
Mailing Address - Country:US
Mailing Address - Phone:530-632-4595
Mailing Address - Fax:
Practice Address - Street 1:163 2ND ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3316
Practice Address - Country:US
Practice Address - Phone:530-632-4595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP3603103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool