Healthcare Provider Details

I. General information

NPI: 1548476831
Provider Name (Legal Business Name): GARY JACK MEIERS PH.D., MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10009 85 AVENUE
EDMONTON ALBERTA
T6E 2J9
CA

IV. Provider business mailing address

10009 85 AVENUE
EDMONTON ALBERTA
T6E 2J9
CA

V. Phone/Fax

Practice location:
  • Phone: 780-433-2269
  • Fax: 780-431-0463
Mailing address:
  • Phone: 780-433-2269
  • Fax: 780-431-0463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number15464
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: