Provider Demographics
NPI:1699845560
Name:MEYER, KEN W (LASW)
Entity Type:Individual
Prefix:MR
First Name:KEN
Middle Name:W
Last Name:MEYER
Suffix:
Gender:M
Credentials:LASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5612 AVENIDA TAMPICO
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4183
Mailing Address - Country:US
Mailing Address - Phone:702-486-5062
Mailing Address - Fax:
Practice Address - Street 1:333 N RANCHO DR
Practice Address - Street 2:SUITE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3797
Practice Address - Country:US
Practice Address - Phone:702-486-5062
Practice Address - Fax:702-486-5029
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0503-A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health