Basic Information
| Provider Information | |||||||||
| NPI: | 1346759933 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEYER | ||||||||
| FirstName: | TREVOR | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | LPC-IT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 E NORTH ST | ||||||||
| Address2: | |||||||||
| City: | FRIENDSHIP | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539349443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083394505 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 108 E NORTH ST | ||||||||
| Address2: | |||||||||
| City: | FRIENDSHIP | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539349443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083394505 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2017 | ||||||||
| LastUpdateDate: | 09/26/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 2956-226 | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 2956-226 | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.