Provider Demographics
NPI:1225051006
Name:MEYER, STEPHEN G (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:G
Last Name:MEYER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 N DIAMOND BAR BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1024
Mailing Address - Country:US
Mailing Address - Phone:909-861-7150
Mailing Address - Fax:909-860-1907
Practice Address - Street 1:732 N DIAMOND BAR BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1024
Practice Address - Country:US
Practice Address - Phone:909-861-7150
Practice Address - Fax:909-860-1907
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2009-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 5149103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical