MEDICARE: LATORIA MYERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1194154302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATORIA MYERS

Provider Business Mailing Address
First Line	:	240 N TILLOTSON AVE
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47304-3988
Country	:	US
Telephone Number	:	765-288-1928
Fax Number	:	765-741-0335

Provider Business Practice Location Address
First Line	:	2506 WILLOW BROOK PARKWAY
Second Line	:	SUITE 102
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-1542
Country	:	US
Telephone Number	:	765-288-1928
Fax Number	:	317-217-1769

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2013
Last Update Date	:	11/07/2013

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Directions to “ LATORIA MYERS ” Practice Location

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