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General NPI Number Information
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NPI Number | 1386734341
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Entity Type | Individual
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Provider Name | PETER RICHARD MYERS LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 1401 GOLD ST
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City | REDDING
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State | CA
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Zip | 96001-1937
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Country | US
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Telephone | 530-238-7133
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Fax |
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Provider Business Mailing Address
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Address Line | 322 E 48TH ST
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City | MINNEAPOLIS
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State | MN
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Zip | 55419-5649
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Country | US
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Telephone | 612-825-5472
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Fax | 651-222-2412
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 88898
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 15195
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License Number State | MN
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