Provider Demographics
NPI:1700473170
Name:MEYER, MATTHEW (MS, LMT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MEYER
Suffix:
Gender:M
Credentials:MS, LMT
Other - Prefix:
Other - First Name:MATTHIAS
Other - Middle Name:
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:701 W SAINT GERMAIN ST STE 206
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-3534
Mailing Address - Country:US
Mailing Address - Phone:320-204-5797
Mailing Address - Fax:
Practice Address - Street 1:701 W SAINT GERMAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-3534
Practice Address - Country:US
Practice Address - Phone:320-204-5797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist