Provider Demographics
NPI:1184217846
Name:VASA, MEREDITH L (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:L
Last Name:VASA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 13TH ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-4609
Mailing Address - Country:US
Mailing Address - Phone:970-685-1523
Mailing Address - Fax:
Practice Address - Street 1:4565 KENDALL PKWY
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9268
Practice Address - Country:US
Practice Address - Phone:855-995-4176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-14
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO.0016886101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health