Healthcare Provider Details

I. General information

NPI: 1285385112
Provider Name (Legal Business Name): DARRIN GLEN MYERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N HAMMES AVE STE 1A
JOLIET IL
60435-8113
US

IV. Provider business mailing address

211 N HAMMES AVE STE 1A
JOLIET IL
60435-8113
US

V. Phone/Fax

Practice location:
  • Phone: 815-290-0902
  • Fax: 509-753-2503
Mailing address:
  • Phone: 815-290-0902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.114631
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number150.114631
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: