Provider Demographics
NPI:1760616429
Name:MEYER, BENT M (MA, LMHC)
Entity Type:Individual
Prefix:MR
First Name:BENT
Middle Name:M
Last Name:MEYER
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 NE 204TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-1524
Mailing Address - Country:US
Mailing Address - Phone:206-225-3794
Mailing Address - Fax:
Practice Address - Street 1:3504 NE 204TH ST
Practice Address - Street 2:
Practice Address - City:LAKE FOREST PARK
Practice Address - State:WA
Practice Address - Zip Code:98155-1524
Practice Address - Country:US
Practice Address - Phone:206-225-3794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60398036103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling