Healthcare Provider Details

I. General information

NPI: 1699699579
Provider Name (Legal Business Name): MRS. NICOLE ELIZABETH MYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 CHESTNUT ST
PAINESVILLE OH
44077-2785
US

IV. Provider business mailing address

5709 TAYLOR RD
PAINESVILLE OH
44077-9155
US

V. Phone/Fax

Practice location:
  • Phone: 440-392-5350
  • Fax:
Mailing address:
  • Phone: 440-799-5870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.01774
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: