Healthcare Provider Details

I. General information

NPI: 1174058044
Provider Name (Legal Business Name): BARBARA MYERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BARBARA SHELTON

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 GLENDALE AVE APT 4
TILTON IL
61833-7973
US

IV. Provider business mailing address

1002 GLENDALE AVE APT 4
TILTON IL
61833-7973
US

V. Phone/Fax

Practice location:
  • Phone: 447-305-5430
  • Fax:
Mailing address:
  • Phone: 447-305-5430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: