Provider Demographics
NPI:1902449218
Name:MYERS, TALITHA R (LCSW)
Entity Type:Individual
Prefix:
First Name:TALITHA
Middle Name:R
Last Name:MYERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 MASSEY RD
Mailing Address - Street 2:
Mailing Address - City:ELDORADO
Mailing Address - State:IL
Mailing Address - Zip Code:62930-3029
Mailing Address - Country:US
Mailing Address - Phone:618-364-7743
Mailing Address - Fax:
Practice Address - Street 1:223 N PARK AVE
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3149
Practice Address - Country:US
Practice Address - Phone:618-706-9050
Practice Address - Fax:618-706-2140
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2023-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0210051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical