MEDICARE: KELLY M MYERS L.M.S.W.

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	1041C0700X	Clinical Social Worker	6801086950	MI

General Provider Information

NPI Number	:	1497080477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY M MYERS L.M.S.W.

Provider Business Mailing Address
First Line	:	38855 HILLS TECH DR
Second Line	:	SUITE 200
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-3421
Country	:	US
Telephone Number	:	248-409-4256
Fax Number	:

Provider Business Practice Location Address
First Line	:	38855 HILLS TECH DR
Second Line	:	SUITE 200
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-3421
Country	:	US
Telephone Number	:	248-409-4256
Fax Number	:

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

Provider Enumeration Date	:	10/09/2009
Last Update Date	:	11/27/2012

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