Provider Demographics
NPI:1831537422
Name:MYERS, CALVIN J (CADC II/LCSW)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:J
Last Name:MYERS
Suffix:
Gender:M
Credentials:CADC II/LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5933 N HAIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-2180
Mailing Address - Country:US
Mailing Address - Phone:310-595-0325
Mailing Address - Fax:
Practice Address - Street 1:10564 SE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2809
Practice Address - Country:US
Practice Address - Phone:503-228-9229
Practice Address - Fax:503-228-9558
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14-02-01101YA0400X
OR17-06-18101YA0400X
CA14564104100000X
ORL55411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500677671Medicaid
OR500680652Medicaid