Healthcare Provider Details

I. General information

NPI: 1548811185
Provider Name (Legal Business Name): ERIC EVANS MYER MA.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 SW 152ND ST
BURIEN WA
98166-1845
US

IV. Provider business mailing address

1210 SW 136TH ST
BURIEN WA
98166-1214
US

V. Phone/Fax

Practice location:
  • Phone: 206-257-6651
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: