Provider Demographics
NPI:1295087799
Name:MYERS, WILLIAM WALTER (MSW)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:WALTER
Last Name:MYERS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-5754
Mailing Address - Country:US
Mailing Address - Phone:231-947-0350
Mailing Address - Fax:231-947-4311
Practice Address - Street 1:402 S UNION ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-5754
Practice Address - Country:US
Practice Address - Phone:231-947-0350
Practice Address - Fax:231-947-4311
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010336921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical