Healthcare Provider Details

I. General information

NPI: 1104782671
Provider Name (Legal Business Name): PETER G MYERS PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 SHERMAN AVE STE 400
EVANSTON IL
60201-4803
US

IV. Provider business mailing address

1555 SHERMAN AVE STE 122
EVANSTON IL
60201-4421
US

V. Phone/Fax

Practice location:
  • Phone: 847-869-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.006398
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: