Provider Demographics
NPI:1912267428
Name:GASSER, MYRA M (LPCI)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:M
Last Name:GASSER
Suffix:
Gender:F
Credentials:LPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 MISTY MORNING DR
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2538
Mailing Address - Country:US
Mailing Address - Phone:843-422-2041
Mailing Address - Fax:
Practice Address - Street 1:7 OFFICE WAY
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29928-7501
Practice Address - Country:US
Practice Address - Phone:843-422-2041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5254101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional