Healthcare Provider Details

I. General information

NPI: 1295750313
Provider Name (Legal Business Name): AMY L MYERS LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3504 WESTRIDGE DR
LAWRENCE KS
66049-2258
US

IV. Provider business mailing address

4925 JEFFERSON WAY
LAWRENCE KS
66049-3595
US

V. Phone/Fax

Practice location:
  • Phone: 785-764-8682
  • Fax:
Mailing address:
  • Phone: 785-764-8682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3784
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1841281805
Identifier TypeOTHER
Identifier StateKS
Identifier IssuerCENTER NPI
# 2
Identifier200439500A
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: