Healthcare Provider Details

I. General information

NPI: 1396106092
Provider Name (Legal Business Name): KARA D MYERS LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 E 12TH AVE
EUGENE OR
97401-3608
US

IV. Provider business mailing address

511 E 12TH AVE
EUGENE OR
97401-3608
US

V. Phone/Fax

Practice location:
  • Phone: 541-514-0393
  • Fax: 541-344-7595
Mailing address:
  • Phone: 541-514-0393
  • Fax: 541-344-7595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL4887
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier500642282
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: KARA D MYERS
Title or Position: SOLE OWNER/MEMBER
Credential: LCSW
Phone: 541-514-0393