Provider Demographics
NPI:1376079871
Name:MEYER, SCARLETT MARIA (LCPC, NCC)
Entity Type:Individual
Prefix:
First Name:SCARLETT
Middle Name:MARIA
Last Name:MEYER
Suffix:
Gender:F
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 FORTUNE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7385
Mailing Address - Country:US
Mailing Address - Phone:618-777-6670
Mailing Address - Fax:
Practice Address - Street 1:1161 FORTUNE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-7385
Practice Address - Country:US
Practice Address - Phone:618-777-6670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.013040101YP2500X
IL180012516101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional