Provider Demographics
NPI:1871077131
Name:MYERS, MARSHALL LOUIS
Entity type:Individual
Prefix:
First Name:MARSHALL
Middle Name:LOUIS
Last Name:MYERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 N YELLOW SPRINGS ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-2463
Mailing Address - Country:US
Mailing Address - Phone:937-399-9500
Mailing Address - Fax:
Practice Address - Street 1:6465 REFLECTIONS DR STE 110
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2353
Practice Address - Country:US
Practice Address - Phone:614-948-3273
Practice Address - Fax:855-740-2025
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC..1901997101YP2500X
OHE.2303428101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty