Healthcare Provider Details

I. General information

NPI: 1821173543
Provider Name (Legal Business Name): CARL L. MYERS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SCOTTSVILLE RD SUITE 100
BOWLING GREEN KY
42104-3217
US

IV. Provider business mailing address

725 HUNTERS POINTE CT
BOWLING GREEN KY
42104-7203
US

V. Phone/Fax

Practice location:
  • Phone: 270-843-8284
  • Fax:
Mailing address:
  • Phone: 270-745-4410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1002
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: