Healthcare Provider Details

I. General information

NPI: 1033203286
Provider Name (Legal Business Name): GREGORY H MEYER M.A. L.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

989 CROMWELL AVE SUITE 330
SAINT PAUL MN
55114-1122
US

IV. Provider business mailing address

989 CROMWELL AVE SUITE 330
SAINT PAUL MN
55114-1122
US

V. Phone/Fax

Practice location:
  • Phone: 651-642-9255
  • Fax: 651-642-1506
Mailing address:
  • Phone: 651-642-9255
  • Fax: 651-642-1506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLP3614
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: