Provider Demographics
NPI:1649370321
Name:MYERS, CYNTHIA M (LMSW ACSW)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:MYERS
Suffix:
Gender:F
Credentials:LMSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6526 DEEPWATER POINT RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:MI
Practice Address - Zip Code:49690-9246
Practice Address - Country:US
Practice Address - Phone:517-627-8357
Practice Address - Fax:517-627-8972
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801033337104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N50560Medicare ID - Type Unspecified