Most Relevant Information
Provider Data
| NPI Number: | 1003486408 |
| Provider Name: | KRISTA MYERS |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | 39003987A |
Most Important Dates
| Enumeration Date: | 06/28/2021 |
| Last Updated: | 06/28/2021 |
Provider Practice Location
4201 LINCOLNWAY E
MISHAWAKA
IN
465444020
Practice Location Phone/Fax
| Phone: | 5748076009 |
| Fax: |
Provider Mailing Location
4201 LINCOLNWAY E
MISHAWAKA
IN
465444020
Provider Mailing Phone/Fax
| Phone: | 5748076009 |
| Fax: |