Provider Demographics
NPI:1073766655
Name:MOHR, MYRA LYNN (LSCSW)
Entity type:Individual
Prefix:MRS
First Name:MYRA
Middle Name:LYNN
Last Name:MOHR
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3624 SE 23RD TERR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66605-1835
Mailing Address - Country:US
Mailing Address - Phone:785-232-9041
Mailing Address - Fax:
Practice Address - Street 1:3624 SE 23RD TERRACE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66605-1835
Practice Address - Country:US
Practice Address - Phone:785-232-9041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW10231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS041152Medicare PIN