Healthcare Provider Details

I. General information

NPI: 1326095134
Provider Name (Legal Business Name): MEIER CLINICS OF MISSOURI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 MAPLE VALLEY DR SUITE C
FARMINGTON MO
63640-1944
US

IV. Provider business mailing address

2100 MANCHESTER RD SUITE 1510
WHEATON IL
60187-4579
US

V. Phone/Fax

Practice location:
  • Phone: 630-653-1717
  • Fax: 630-653-1025
Mailing address:
  • Phone: 630-653-1717
  • Fax: 630-653-1025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2003032053
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001957
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR8014
License Number StateMO

VIII. Authorized Official

Name: HEATHER GANDY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 630-653-1717