Provider Demographics
NPI:1023560679
Name:MERIDIAN MENTORING
Entity Type:Organization
Organization Name:MERIDIAN MENTORING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MCKETTE
Authorized Official - Middle Name:H
Authorized Official - Last Name:ALLRED
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:801-793-0976
Mailing Address - Street 1:PO BOX 1263
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84528-1263
Mailing Address - Country:US
Mailing Address - Phone:801-793-0976
Mailing Address - Fax:
Practice Address - Street 1:635 SOUTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:ORANGEVILLE
Practice Address - State:UT
Practice Address - Zip Code:84537
Practice Address - Country:US
Practice Address - Phone:801-793-0976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children