Provider Demographics
NPI:1679807986
Name:MEYER, SCOTT RICHARD (RI-M0909081620)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:RICHARD
Last Name:MEYER
Suffix:
Gender:M
Credentials:RI-M0909081620
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6222 GOLD DUST DR.
Mailing Address - Street 2:
Mailing Address - City:KELSEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95451
Mailing Address - Country:US
Mailing Address - Phone:707-349-7351
Mailing Address - Fax:
Practice Address - Street 1:6222 GOLD DUST DR
Practice Address - Street 2:
Practice Address - City:KELSEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95451-9214
Practice Address - Country:US
Practice Address - Phone:707-349-7351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-M0909081620101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARI-M0909081620OtherSUBSTANCE ABUSE DISORDER
CARI-M0909081620OtherADDICTION