Provider Demographics
NPI:1215176698
Name:MYERS COUNSELING GROUP
Entity type:Organization
Organization Name:MYERS COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-263-1269
Mailing Address - Street 1:300 MEMORIAL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6278
Mailing Address - Country:US
Mailing Address - Phone:847-263-1269
Mailing Address - Fax:
Practice Address - Street 1:300 MEMORIAL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6278
Practice Address - Country:US
Practice Address - Phone:847-263-1269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006053101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty