Provider Demographics
NPI:1255433751
Name:MYER, JASON DAVID (MED, LPC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:DAVID
Last Name:MYER
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 9TH AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-8069
Mailing Address - Country:US
Mailing Address - Phone:409-729-8805
Mailing Address - Fax:409-729-4084
Practice Address - Street 1:8700 9TH AVE STE 106
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8069
Practice Address - Country:US
Practice Address - Phone:409-729-8805
Practice Address - Fax:409-729-4084
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17027101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health