Provider Demographics
NPI:1508606930
Name:MYERS, JANIE ALEX (MA)
Entity type:Individual
Prefix:
First Name:JANIE
Middle Name:ALEX
Last Name:MYERS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S BEECH DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7827
Mailing Address - Country:US
Mailing Address - Phone:512-540-1554
Mailing Address - Fax:
Practice Address - Street 1:405 N BEAVER ST STE 9
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4500
Practice Address - Country:US
Practice Address - Phone:928-286-7229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty