Provider Demographics
NPI:1649712001
Name:MEYER, ALEXANDER C (LGSW, LADC)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:C
Last Name:MEYER
Suffix:
Gender:M
Credentials:LGSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 NW 1ST AVE # 5
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-2619
Mailing Address - Country:US
Mailing Address - Phone:121-830-2446
Mailing Address - Fax:
Practice Address - Street 1:1200 S POKEGAMA AVE STE 160
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-4296
Practice Address - Country:US
Practice Address - Phone:218-999-0051
Practice Address - Fax:218-999-7020
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303335101YA0400X
MN23421104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)