Basic Information
| Provider Information | |||||||||
| NPI: | 1972840700 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MYERS | ||||||||
| FirstName: | DIANA | ||||||||
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| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1175 NEWARK RD | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437012618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404540738 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10400 BLACKLICK EASTERN RD | ||||||||
| Address2: | |||||||||
| City: | PICKERINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431478235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7408689362 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2013 | ||||||||
| LastUpdateDate: | 09/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 0700070 | OH | N | Behavioral Health & Social Service Providers | Counselor | 104100000X | I.0700070 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.