Provider Demographics
NPI:1396106092
Name:KARA D MYERS LCSW LLC
Entity type:Organization
Organization Name:KARA D MYERS LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-514-0393
Mailing Address - Street 1:511 E 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3608
Mailing Address - Country:US
Mailing Address - Phone:541-514-0393
Mailing Address - Fax:541-344-7595
Practice Address - Street 1:511 E 12TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3608
Practice Address - Country:US
Practice Address - Phone:541-514-0393
Practice Address - Fax:541-344-7595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL48871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500642282Medicaid