Provider Demographics
NPI:1134190317
Name:MYHRE, JAMES DONALD (LPC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DONALD
Last Name:MYHRE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MO
Mailing Address - Zip Code:65605-1518
Mailing Address - Country:US
Mailing Address - Phone:417-678-5532
Mailing Address - Fax:417-678-6242
Practice Address - Street 1:308 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605-1518
Practice Address - Country:US
Practice Address - Phone:417-678-5532
Practice Address - Fax:417-678-6242
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002031921101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496045816Medicaid