Healthcare Provider Details

I. General information

NPI: 1215847793
Provider Name (Legal Business Name): CHANA MYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 AXTELL DR STE 100
TROY MI
48084-4400
US

IV. Provider business mailing address

25800 SOUTHWOOD DR
SOUTHFIELD MI
48075-2091
US

V. Phone/Fax

Practice location:
  • Phone: 248-973-4060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451025296
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: