Healthcare Provider Details

I. General information

NPI: 1437065117
Provider Name (Legal Business Name): MADISON RENEE MYERS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 21ST AVE N
MYRTLE BEACH SC
29577-7401
US

IV. Provider business mailing address

227 BERMUDA BAY DR
MYRTLE BEACH SC
29579-4645
US

V. Phone/Fax

Practice location:
  • Phone: 843-450-8152
  • Fax:
Mailing address:
  • Phone: 843-450-8152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2842387
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: