Healthcare Provider Details

I. General information

NPI: 1174181440
Provider Name (Legal Business Name): STACEY MYERS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 E 116TH ST STE 112
CARMEL IN
46032-3572
US

IV. Provider business mailing address

631 NUTTAL ST
WESTFIELD IN
46074-5801
US

V. Phone/Fax

Practice location:
  • Phone: 317-804-4540
  • Fax: 317-755-0676
Mailing address:
  • Phone: 317-500-3624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39003539A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number39003539A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: