Individual
JESSICA LYNN MYERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC-S, LICDC-CS
Contact information
Practice address
3095 KETTERING BLVD, MORAINE, OH 45439-1983
(937) 293-8300
Mailing address
2206 SHROYER RD, OAKWOOD, OH 45419-2623
(937) 367-7399
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LICDC.161309
OH
101YP2500X
Professional Counselor
Primary
E.1800725-SUPV
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0186751
—
OH
Enumeration date
09/04/2015
Last updated
09/28/2021
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