Provider Demographics
NPI:1497126288
Name:MEYER, DOUGLAS J (MFT)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:J
Last Name:MEYER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4017
Mailing Address - Country:US
Mailing Address - Phone:510-251-3952
Mailing Address - Fax:510-251-3954
Practice Address - Street 1:969 BROADWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4017
Practice Address - Country:US
Practice Address - Phone:510-251-3952
Practice Address - Fax:510-251-3954
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73370106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist