Basic Information
Provider Information
NPI: 1639372808
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MEYER
FirstName: BARBARA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CDP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 2635
Address2:  
City: PORT ANGELES
State: WA
PostalCode: 983620330
CountryCode: US
TelephoneNumber: 3604524432
FaxNumber:  
Practice Location
Address1: 1026 E 1ST ST STE 2
Address2:  
City: PORT ANGELES
State: WA
PostalCode: 983620330
CountryCode: US
TelephoneNumber: 3604524432
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/06/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YA0400X  Y Behavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)

No ID Information.


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