Doctor Name: | CONNIE NICHOLS MEYER |
NPI Number: | 1073636932 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA |
License Number: | 3999 |
Business Practice Address: | 3206 W Owasso Blvd Shoreview, MN - 551264138 |
Business Phone Number: | 6514909891 |
Business Fax Number: | |
Mailing Address: | 3206 W Owasso Blvd, SHOREVIEW |
State: | MN |
Postal Code: | 551264138 |
Phone Number: | 6514909891 |
Fax Number: | |
NPI Enumeration Date: | 04/07/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC1900X |
License Number: | 3999 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Counseling |
Taxonomy Definition: |