Healthcare Provider Details

I. General information

NPI: 1497104376
Provider Name (Legal Business Name): JAMAL L MYERS LMHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 FREEMAN RD E
FIFE WA
98424-3776
US

IV. Provider business mailing address

16008 210TH AVE E
BONNEY LAKE WA
98391-9253
US

V. Phone/Fax

Practice location:
  • Phone: 253-389-0939
  • Fax: 253-319-7236
Mailing address:
  • Phone: 602-650-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.60961109
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: