Provider Demographics
NPI:1932534815
Name:MYERS, THOMAS MICHAEL (LMHC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:MYERS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5643 STEWART ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-4227
Mailing Address - Country:US
Mailing Address - Phone:850-983-4455
Mailing Address - Fax:850-623-1219
Practice Address - Street 1:5643 STEWART ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-4227
Practice Address - Country:US
Practice Address - Phone:850-983-4455
Practice Address - Fax:850-623-1219
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11969101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health