Provider Demographics
NPI:1447535976
Name:MYERS, AMY ALLISON (MS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ALLISON
Last Name:MYERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 114TH AVE SE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6945
Mailing Address - Country:US
Mailing Address - Phone:425-922-5605
Mailing Address - Fax:
Practice Address - Street 1:1715 114TH AVE SE
Practice Address - Street 2:SUITE 208
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6945
Practice Address - Country:US
Practice Address - Phone:425-922-5605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-16
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG 60241593106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist