Healthcare Provider Details

I. General information

NPI: 1568723724
Provider Name (Legal Business Name): PAUL JOHNATHAN MEYER MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 12/14/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 W MAIN ST
GRASS VALLEY CA
95945-6410
US

IV. Provider business mailing address

128 EAST ST
AUBURN CA
95603-5119
US

V. Phone/Fax

Practice location:
  • Phone: 530-477-9800
  • Fax:
Mailing address:
  • Phone: 916-269-9657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number128142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: