Provider Demographics
NPI:1285138370
Name:MEISTER, JOHN RAYMOND (MDIVINITY, IADC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:RAYMOND
Last Name:MEISTER
Suffix:
Gender:M
Credentials:MDIVINITY, IADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 VINE ST STE 2210
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-4469
Mailing Address - Country:US
Mailing Address - Phone:515-619-6976
Mailing Address - Fax:
Practice Address - Street 1:1985 NE 51ST PL
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50313-2517
Practice Address - Country:US
Practice Address - Phone:515-222-0910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14073101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)