Provider Demographics
NPI:1407205248
Name:MEYER, BENJAMIN (LPC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:MEYER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W CLARENDON AVE UNIT 18A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3442
Mailing Address - Country:US
Mailing Address - Phone:614-705-3044
Mailing Address - Fax:
Practice Address - Street 1:4700 S MILL AVE STE 5
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-6736
Practice Address - Country:US
Practice Address - Phone:614-705-3044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-11
Last Update Date:2021-09-01
Deactivation Date:2019-07-27
Deactivation Code:
Reactivation Date:2019-08-07
Provider Licenses
StateLicense IDTaxonomies
OHC.1901960101YM0800X
AZLAC 15844101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH036813Medicaid