1053828996 NPI number — JESSICA LYNNE MEYER LMHC CADAC IV

Table of content: JESSICA LYNNE MEYER LMHC CADAC IV (NPI 1053828996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053828996 NPI number — JESSICA LYNNE MEYER LMHC CADAC IV

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEYER
Provider First Name:
JESSICA
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC CADAC IV
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053828996
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2895
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CULLMAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35056-2895
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-735-5570
Provider Business Mailing Address Fax Number:
256-735-5571

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1948 AL HIGHWAY 157 STE 360
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CULLMAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35058-0604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-735-5570
Provider Business Practice Location Address Fax Number:
256-203-8684
Provider Enumeration Date:
01/01/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  39002740A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 03896 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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