Provider Demographics
NPI:1245311356
Name:MEYER, BRIAN L (PHD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:L
Last Name:MEYER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 BROAD ROCK BLVD
Mailing Address - Street 2:ROOM 1E 144
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23249-0001
Mailing Address - Country:US
Mailing Address - Phone:804-675-5000
Mailing Address - Fax:804-675-6853
Practice Address - Street 1:1201 BROAD ROCK BLVD
Practice Address - Street 2:ROOM 1E 144
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-5000
Practice Address - Fax:804-675-6853
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003187103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007713711 541581185Medicaid
VA000356M94 C03694Medicare ID - Type Unspecified
VA007713711 541581185Medicaid