MEDICARE: ANGELENE MARIE MYERS LPC

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	101YP2500X	Professional Counselor	2912	CO

General Provider Information

NPI Number	:	1689970063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELENE MARIE MYERS LPC

Provider Business Mailing Address
First Line	:	4880 DRY STONE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-5165
Country	:	US
Telephone Number	:	719-659-8357
Fax Number	:

Provider Business Practice Location Address
First Line	:	6745 RANGEWOOD DR STE 230
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-7105
Country	:	US
Telephone Number	:	719-659-8357
Fax Number	:

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

Provider Enumeration Date	:	02/02/2011
Last Update Date	:	05/04/2020

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