Healthcare Provider Details

I. General information

NPI: 1467536193
Provider Name (Legal Business Name): JOSHUA GARY MYERS PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 DIAMOND CENTRE CT SUITE 1003
FORT MYERS FL
33912-4365
US

IV. Provider business mailing address

7768 WOODLAND BEND CIR
FORT MYERS FL
33912-5634
US

V. Phone/Fax

Practice location:
  • Phone: 239-561-9955
  • Fax: 239-561-9779
Mailing address:
  • Phone: 239-561-9955
  • Fax: 239-561-9779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY6395
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: