Provider Demographics
NPI:1689160079
Name:MEYERS, ANGELA (PHD, LPC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MEYERS
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:CHAMBERLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 COMMUNITY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-8804
Mailing Address - Country:US
Mailing Address - Phone:660-885-8131
Mailing Address - Fax:
Practice Address - Street 1:155 PARK DR
Practice Address - Street 2:
Practice Address - City:SAINT ROBERT
Practice Address - State:MO
Practice Address - Zip Code:65584-7860
Practice Address - Country:US
Practice Address - Phone:844-853-8937
Practice Address - Fax:573-364-6302
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018022858101YP2500X, 101YP2500X
MO2023009820103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490056897Medicaid