Provider Demographics
NPI:1497023212
Name:MEYER, GREGORY SCOTT (LCSW, CBIS)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:SCOTT
Last Name:MEYER
Suffix:
Gender:M
Credentials:LCSW, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N ROBBINS RD
Mailing Address - Street 2:IDAO ELKS REHAB HOSPITAL
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702
Mailing Address - Country:US
Mailing Address - Phone:208-480-4963
Mailing Address - Fax:208-489-4053
Practice Address - Street 1:600 N ROBBINS RD
Practice Address - Street 2:IDAO ELKS REHAB HOSPITAL
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4565
Practice Address - Country:US
Practice Address - Phone:208-480-4963
Practice Address - Fax:208-489-4053
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW250221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical