Provider Demographics
NPI:1225752660
Name:MEEKER, GRETTA LYNNN
Entity Type:Individual
Prefix:
First Name:GRETTA
Middle Name:LYNNN
Last Name:MEEKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 S 54TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8191
Mailing Address - Country:US
Mailing Address - Phone:850-982-3549
Mailing Address - Fax:
Practice Address - Street 1:2105 S 54TH ST STE 1
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8191
Practice Address - Country:US
Practice Address - Phone:850-982-3549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1701222101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional