Healthcare Provider Details

I. General information

NPI: 1447974522
Provider Name (Legal Business Name): MONTANA MEYER MA, TLMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 10/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38150 253RD AVE
LA MOTTE IA
52054-9605
US

IV. Provider business mailing address

38150 253RD AVE
LA MOTTE IA
52054-9605
US

V. Phone/Fax

Practice location:
  • Phone: 563-581-5063
  • Fax:
Mailing address:
  • Phone: 563-581-5063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number116521
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: