Provider Demographics
NPI:1386734341
Name:MYERS, PETER RICHARD (LCSW)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:RICHARD
Last Name:MYERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 E 48TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-5649
Mailing Address - Country:US
Mailing Address - Phone:612-825-5472
Mailing Address - Fax:651-222-2412
Practice Address - Street 1:1401 GOLD ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1937
Practice Address - Country:US
Practice Address - Phone:530-238-7133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA888981041C0700X
MN151951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical