Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | LP3614 | MN |
NPI | 1033203286 |
---|---|
Provider Name | Mr. Gregory H Meyer |
First Address | Saint Paul, MN 55114-1122 |
Second Address | Saint Paul, MN 55114-1122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30Q94ME | BLUE CROSS/BLUE SHIELD (01) | MN |
6290028 | MEDICA (01) | MN |