Provider Demographics
NPI:1417180902
Name:MEYER, MARY E (PHD, LMFT, CSAT)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:MEYER
Suffix:
Gender:F
Credentials:PHD, LMFT, CSAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 SE DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-9364
Mailing Address - Country:US
Mailing Address - Phone:515-705-0174
Mailing Address - Fax:
Practice Address - Street 1:602 SE DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-9364
Practice Address - Country:US
Practice Address - Phone:515-705-0174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.001000106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE96065OtherBCBS
NE$$$$$$$$$Medicaid