Provider Demographics
NPI:1386028199
Name:MEYER, RYAN WELLS (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:WELLS
Last Name:MEYER
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 MONTREAL AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-2393
Mailing Address - Country:US
Mailing Address - Phone:651-313-8080
Mailing Address - Fax:651-433-7122
Practice Address - Street 1:1150 MONTREAL AVE STE 107
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-2393
Practice Address - Country:US
Practice Address - Phone:651-313-8080
Practice Address - Fax:651-433-7122
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01041101YP2500X
MN1547101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health