Provider Demographics
NPI:1528179918
Name:MEYER, STEPHANIE K (LIMHP, CPC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:K
Last Name:MEYER
Suffix:
Gender:F
Credentials:LIMHP, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5561 S 48TH ST
Mailing Address - Street 2:STE 201D
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4109
Mailing Address - Country:US
Mailing Address - Phone:402-421-8255
Mailing Address - Fax:
Practice Address - Street 1:5561 S 48TH ST
Practice Address - Street 2:STE 201D
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4109
Practice Address - Country:US
Practice Address - Phone:402-421-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE695101YM0800X
NE1819101YM0800X
NE1085101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025315500Medicaid
203541651OtherEIN