Basic Information
| Provider Information | |||||||||
| NPI: | 1912175183 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MYERS | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC-I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11754 JOLLYVILLE RD STE 110 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787593948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123312700 | ||||||||
| FaxNumber: | 5122195097 | ||||||||
| Practice Location | |||||||||
| Address1: | 11754 JOLLYVILLE RD STE 110 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787593948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123312700 | ||||||||
| FaxNumber: | 5122195097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2008 | ||||||||
| LastUpdateDate: | 02/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 63765 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.