MEDICARE: DR. KARA MEYER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist	PY61046646	WA
2	103TC2200X	Clinical Child & Adolescent Psychologist	PY61046646	WA
3	103TC0700X	Clinical Psychologist	PY60146646	WA

General Provider Information

NPI Number	:	1740591486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARA MEYER PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 6422
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98507-6422
Country	:	US
Telephone Number	:	360-402-6117
Fax Number	:	360-512-3656

Provider Business Practice Location Address
First Line	:	825 LEGION WAY SE
Second Line	:	STE D
City	:	OLYMPIA
State	:	WA
Zip	:	98501-1586
Country	:	US
Telephone Number	:	360-402-6117
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2010
Last Update Date	:	02/24/2016

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