Provider Demographics
NPI:1093702573
Name:JOHNMEYER, CONNIE (PHD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:JOHNMEYER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 7 BOX 469
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09104
Mailing Address - Country:DE
Mailing Address - Phone:0245-199-3378
Mailing Address - Fax:
Practice Address - Street 1:PSC 7 BOX 469
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09104
Practice Address - Country:DE
Practice Address - Phone:0245-199-3378
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0522103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical