Provider Demographics
NPI:1285818203
Name:O'MARA MEYER, JULIE ELLEN (LP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ELLEN
Last Name:O'MARA MEYER
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5293 COUNTY ROAD 3
Mailing Address - Street 2:
Mailing Address - City:HOKAH
Mailing Address - State:MN
Mailing Address - Zip Code:55941
Mailing Address - Country:US
Mailing Address - Phone:507-724-5745
Mailing Address - Fax:
Practice Address - Street 1:511 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MN
Practice Address - Zip Code:55921-1869
Practice Address - Country:US
Practice Address - Phone:507-725-5205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3010103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist