MEDICARE: MRS. MYA CHARLES

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	101YM0800X	Mental Health Counselor	PLC10796	LA

General Provider Information

NPI Number	:	1932085172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MYA CHARLES

Provider Business Mailing Address
First Line	:	2020 W PINHOOK RD STE 204
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3211
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 W PINHOOK RD STE 204
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3211
Country	:	US
Telephone Number	:	337-261-8781
Fax Number	:

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

Provider Enumeration Date	:	08/13/2025
Last Update Date	:	08/13/2025

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