Provider Demographics
NPI:1144765595
Name:MEYER, CODY RUSSELL (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:CODY
Middle Name:RUSSELL
Last Name:MEYER
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6214 NAGEL AVE APT 1E
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-3851
Mailing Address - Country:US
Mailing Address - Phone:618-567-6995
Mailing Address - Fax:
Practice Address - Street 1:6260 E COLFAX AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-1515
Practice Address - Country:US
Practice Address - Phone:303-837-0166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health