Basic Information
Provider Information
NPI: 1326398942
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MYERS
FirstName: HARRIET
MiddleName: H
NamePrefix:  
NameSuffix:  
Credential: PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 850 5TH AVE E
Address2:  
City: TUSCALOOSA
State: AL
PostalCode: 354017419
CountryCode: US
TelephoneNumber: 2053481770
FaxNumber: 2053485676
Practice Location
Address1: 850 5TH AVE E
Address2:  
City: TUSCALOOSA
State: AL
PostalCode: 354017419
CountryCode: US
TelephoneNumber: 2053481770
FaxNumber: 2053485676
Other Information
ProviderEnumerationDate: 09/11/2012
LastUpdateDate: 01/09/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103T00000X399ALY Behavioral Health & Social Service ProvidersPsychologist 

No ID Information.


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