Healthcare Provider Details

I. General information

NPI: 1538094719
Provider Name (Legal Business Name): MICHAEL G MYERS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 S 36TH ST STE 400
QUINCY IL
62301-5801
US

IV. Provider business mailing address

913 W LINE ST
PALMYRA MO
63461-1823
US

V. Phone/Fax

Practice location:
  • Phone: 217-228-6194
  • Fax:
Mailing address:
  • Phone: 217-209-1644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.023044
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: