Provider Demographics
NPI:1144453622
Name:DEMPSEY, MYRA JOY (PC-CR)
Entity type:Individual
Prefix:MRS
First Name:MYRA
Middle Name:JOY
Last Name:DEMPSEY
Suffix:
Gender:F
Credentials:PC-CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MILLPOND RD
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43074-8453
Mailing Address - Country:US
Mailing Address - Phone:614-949-3415
Mailing Address - Fax:
Practice Address - Street 1:225 GREEN MEADOWS DR S
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-9714
Practice Address - Country:US
Practice Address - Phone:614-791-4444
Practice Address - Fax:740-881-0933
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0800298101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08258Medicaid