Provider Demographics
NPI:1679690820
Name:MYERS, CHARLES EDWIN (PHD,LPC,LMHC,RPTS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDWIN
Last Name:MYERS
Suffix:
Gender:M
Credentials:PHD,LPC,LMHC,RPTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 CYRUS WAY
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-7568
Mailing Address - Country:US
Mailing Address - Phone:817-403-0860
Mailing Address - Fax:
Practice Address - Street 1:4252 E FARM ROAD 64
Practice Address - Street 2:
Practice Address - City:FAIR GROVE
Practice Address - State:MO
Practice Address - Zip Code:65648-8308
Practice Address - Country:US
Practice Address - Phone:417-836-5256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8288101YM0800X
MO2021021781101YP2500X
KY170707101YP2500X
TX19778101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health