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General NPI Number Information
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NPI Number | 1083046148
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Entity Type | Individual
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Provider Name | VICTOR E MYERS LPC
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Gender | Male
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Dates
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Enumeration Date | 07/31/2013
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 690 S INDUSTRY WAY STE 45
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City | MERIDIAN
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State | ID
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Zip | 83642-7907
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Country | US
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Telephone | 208-922-2207
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Fax | 208-922-4168
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Provider Business Mailing Address
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Address Line | 519 W BOISE AVE
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City | BOISE
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State | ID
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Zip | 83706-4339
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Country | US
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Telephone | 208-891-0318
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5325
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5325
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License Number State | ID
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