Provider Demographics
NPI:1043598360
Name:MEYER, WADE (MDIV)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:
Last Name:MEYER
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 HEARST AVE STE 203A
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-2130
Mailing Address - Country:US
Mailing Address - Phone:510-981-1471
Mailing Address - Fax:844-630-3965
Practice Address - Street 1:2000 HEARST AVE STE 203A
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-2260
Practice Address - Country:US
Practice Address - Phone:510-981-1471
Practice Address - Fax:844-630-3965
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor