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NPI Code Detail

MEDICARE: MR. JAMES ROBERT MYERS MA, CCM

MEDICARE: MR. JAMES ROBERT MYERS MA, CCM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1235350174
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES ROBERT MYERS MA, CCM
Provider Business Mailing Address
First Line : 2614 LAKEVIEW DR
Second Line :
City : SAINT ALBANS
State : WV
Zip : 25177-3426
Country : US
Telephone Number : 304-727-8650
Fax Number :
Provider Business Practice Location Address
First Line : 135 4TH AVE
Second Line :
City : HUNTINGTON
State : WV
Zip : 25701-1219
Country : US
Telephone Number : 304-525-5691
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2007
Last Update Date : 07/08/2007

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