Provider Demographics
NPI:1427256833
Name:MEYER, KEITH ROBERT (MS, LMHC)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:ROBERT
Last Name:MEYER
Suffix:
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3627 ENSIGN RD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5024
Mailing Address - Country:US
Mailing Address - Phone:360-250-0781
Mailing Address - Fax:360-705-2566
Practice Address - Street 1:3627 ENSIGN RD NE
Practice Address - Street 2:SUITE A
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5024
Practice Address - Country:US
Practice Address - Phone:360-250-0781
Practice Address - Fax:360-705-2566
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004853101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health