Healthcare Provider Details

I. General information

NPI: 1790720415
Provider Name (Legal Business Name): STASIA LYN WIER MYERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11501 FINANCIAL CENTRE PKWY
LITTLE ROCK AR
72211-3715
US

IV. Provider business mailing address

11501 FINANCIAL CENTRE PKWY
LITTLE ROCK AR
72211-3715
US

V. Phone/Fax

Practice location:
  • Phone: 330-758-4515
  • Fax: 330-758-5121
Mailing address:
  • Phone: 330-758-4515
  • Fax: 330-758-5121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2011-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: