Provider Demographics
NPI:1255529657
Name:MEYER, DEANNA LEE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:LEE
Last Name:MEYER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 MACERO ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-5000
Mailing Address - Country:US
Mailing Address - Phone:916-821-4159
Mailing Address - Fax:
Practice Address - Street 1:1133 COLOMA WAY
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4480
Practice Address - Country:US
Practice Address - Phone:916-774-6647
Practice Address - Fax:916-774-6456
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA130058106H00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1255529657OtherLICENSED MARRIAGE AND FAMILY THERAPIST