Provider Demographics
NPI:1962047209
Name:MYERS, KRYSTAL ANN (RCSWI)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:ANN
Last Name:MYERS
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:ANN
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2345 SAND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-9142
Mailing Address - Country:US
Mailing Address - Phone:937-371-9439
Mailing Address - Fax:
Practice Address - Street 1:2345 SAND LAKE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-9142
Practice Address - Country:US
Practice Address - Phone:937-371-9439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-11
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW130421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical