Provider Demographics
NPI:1386267987
Name:MYERS, STEFANIE (MSW, LGSW)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-4086
Mailing Address - Country:US
Mailing Address - Phone:812-238-7384
Mailing Address - Fax:812-238-7002
Practice Address - Street 1:1801 N 6TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-4086
Practice Address - Country:US
Practice Address - Phone:812-238-7384
Practice Address - Fax:812-238-7002
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34010367A1041C0700X
WVSW042015487104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker