Healthcare Provider Details

I. General information

NPI: 1780999680
Provider Name (Legal Business Name): MEYER PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 08/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 S. CONGRESS OUTPATIENT CLINIC #3
RUSHVILLE IL
62681
US

IV. Provider business mailing address

PO BOX 85
RUSHVILLE IL
62681-0085
US

V. Phone/Fax

Practice location:
  • Phone: 217-322-2575
  • Fax: 217-322-2574
Mailing address:
  • Phone: 217-322-2575
  • Fax: 217-322-2574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number098.000093
License Number StateIL

VIII. Authorized Official

Name: DR. PAMELA C. H. MEYER
Title or Position: DR./OWNER/CEO
Credential: PSY.D., LCP
Phone: 217-322-2575