Provider Demographics
NPI:1275834996
Name:MEYER, JOEL THOMAS (MA)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:THOMAS
Last Name:MEYER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 LONGFELLOW DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-4819
Mailing Address - Country:US
Mailing Address - Phone:312-480-7302
Mailing Address - Fax:
Practice Address - Street 1:1090 LONGFELLOW DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-4819
Practice Address - Country:US
Practice Address - Phone:409-898-4575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007491101YP2500X
TX67792101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional