MEDICARE: KERRY J MYERS MFT ASSOCIATE

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	106H00000X	Marriage & Family Therapist	R8298	OR

General Provider Information

NPI Number	:	1518653856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRY J MYERS MFT ASSOCIATE

Provider Business Mailing Address
First Line	:	2850 SW CEDAR HILLS BLVD # 1189
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97005-1354
Country	:	US
Telephone Number	:	818-606-3685
Fax Number	:

Provider Business Practice Location Address
First Line	:	10275 NW ALDER GROVE LN
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97229-7584
Country	:	US
Telephone Number	:	818-606-3685
Fax Number	:

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

Provider Enumeration Date	:	04/11/2023
Last Update Date	:	04/11/2023

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