Provider Demographics
NPI:1699263046
Name:MEYER, CARL CLAUS (LICDC-CS)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:CLAUS
Last Name:MEYER
Suffix:
Gender:M
Credentials:LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44286-9510
Mailing Address - Country:US
Mailing Address - Phone:440-570-5782
Mailing Address - Fax:
Practice Address - Street 1:11811 SHAKER BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1931
Practice Address - Country:US
Practice Address - Phone:216-862-1084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH933451OtherLICDC