=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598819252
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICIA LOUISE MYERS M.ED., LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1208 FM 2824
-----------------------------------------------------
City | BEEVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78102-8229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-358-1825
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1208 FM 2824
-----------------------------------------------------
City | BEEVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78102-8229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-358-1825
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171W00000X
-----------------------------------------------------
Taxonomy Name | Contractor
-----------------------------------------------------
License Number | LPC #02601
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------