MEDICARE: MS. CAROLE ANN MYRE LPC

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
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1790856276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLE ANN MYRE LPC

Provider Business Mailing Address
First Line	:	1265 ROGUE RIVER CT
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-2439
Country	:	US
Telephone Number	:	636-728-9034
Fax Number	:

Provider Business Practice Location Address
First Line	:	1265 ROGUE RIVER CT
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-2439
Country	:	US
Telephone Number	:	636-728-9034
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	06/14/2023

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