Provider Demographics
NPI:1033203286
Name:MEYER, GREGORY H (MA LP)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:H
Last Name:MEYER
Suffix:
Gender:M
Credentials:MA LP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:989 CROMWELL AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1122
Mailing Address - Country:US
Mailing Address - Phone:651-642-9255
Mailing Address - Fax:651-642-1506
Practice Address - Street 1:989 CROMWELL AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1122
Practice Address - Country:US
Practice Address - Phone:651-642-9255
Practice Address - Fax:651-642-1506
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP3614103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN30Q94MEOtherBLUE CROSS/BLUE SHIELD
MN6290028OtherMEDICA