Provider Demographics
NPI:1457360737
Name:MEYER, JOHN H (EDD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:MEYER
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:H
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMHC
Mailing Address - Street 1:88 OLDE ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-6769
Mailing Address - Country:US
Mailing Address - Phone:802-985-8202
Mailing Address - Fax:
Practice Address - Street 1:88 OLDE ORCHARD LN
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-6769
Practice Address - Country:US
Practice Address - Phone:802-985-8202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000079101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009588Medicaid