=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407055916
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTINA MYERS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2007
-----------------------------------------------------
Last Update Date | 07/13/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 W HIGH ST SUITE 810
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45502-1233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-323-3145
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 W HIGH ST SUITE 810
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45502-1233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-323-3145
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPRIETOR
-----------------------------------------------------
Name | CHRISTINA MYERS
-----------------------------------------------------
Credential | LPCC
-----------------------------------------------------
Telephone | 937-323-3145
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | E0002424
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------