Healthcare Provider Details

I. General information

NPI: 1346630753
Provider Name (Legal Business Name): PAMELA MYERS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 HALF DAY RD
BANNOCKBURN IL
60015-1217
US

IV. Provider business mailing address

42 S MAYWOOD RD
LAKE FOREST IL
60045-3265
US

V. Phone/Fax

Practice location:
  • Phone: 773-251-7262
  • Fax:
Mailing address:
  • Phone: 773-251-7262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: