Provider Demographics
NPI:1780999680
Name:MEYER PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:MEYER PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR./OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:C H
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LCP
Authorized Official - Phone:217-322-2575
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62681-0085
Mailing Address - Country:US
Mailing Address - Phone:217-322-2575
Mailing Address - Fax:217-322-2574
Practice Address - Street 1:238 S. CONGRESS
Practice Address - Street 2:OUTPATIENT CLINIC #3
Practice Address - City:RUSHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62681
Practice Address - Country:US
Practice Address - Phone:217-322-2575
Practice Address - Fax:217-322-2574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL098.000093251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1134390503OtherINDIVIDUAL NPI OF OWNER