Provider Demographics
NPI:1912074097
Name:MYERS, LINDA D (MA)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:D
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 1:11920 DUSTY ROSE RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-1270
Mailing Address - Country:US
Mailing Address - Phone:505-823-2323
Mailing Address - Fax:425-940-2716
Practice Address - Street 1:8220 LA MIRADA PL NE STE 200
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1658
Practice Address - Country:US
Practice Address - Phone:505-823-2323
Practice Address - Fax:425-940-2716
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0087581101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional