Provider Demographics
NPI:1295729176
Name:MYER, KELLY CASBON (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:CASBON
Last Name:MYER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19221 I-45 SOUTH
Mailing Address - Street 2:STE 440
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385
Mailing Address - Country:US
Mailing Address - Phone:832-367-4486
Mailing Address - Fax:281-681-1008
Practice Address - Street 1:330 RAYFORD RD
Practice Address - Street 2:PMB# 247
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-1980
Practice Address - Country:US
Practice Address - Phone:832-367-4486
Practice Address - Fax:281-681-1008
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23043104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82223WMedicare ID - Type Unspecified
S80081Medicare UPIN