Basic Information
| Provider Information | |||||||||
| NPI: | 1740673037 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MYERS | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | JOY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7610 40TH ST W STE 200 | ||||||||
| Address2: | |||||||||
| City: | UNIVERSITY PLACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984663838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535077231 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7610 40TH ST W STE 200 | ||||||||
| Address2: | |||||||||
| City: | UNIVERSITY PLACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535077231 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2015 | ||||||||
| LastUpdateDate: | 09/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CG60542500 | WA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.