Provider Demographics
NPI:1619281326
Name:MEYER, JAMES B
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:MEYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 BAKERVIEW PL
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-5789
Mailing Address - Country:US
Mailing Address - Phone:360-848-7758
Mailing Address - Fax:
Practice Address - Street 1:2821 MISSION HILL RD
Practice Address - Street 2:
Practice Address - City:TULALIP
Practice Address - State:WA
Practice Address - Zip Code:98271-9706
Practice Address - Country:US
Practice Address - Phone:360-716-4400
Practice Address - Fax:360-651-4404
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACDP 6310101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)