Provider Demographics
NPI:1265512065
Name:MERIWETHER, LESLEY (RN/MFT)
Entity Type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:
Last Name:MERIWETHER
Suffix:
Gender:F
Credentials:RN/MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 H ST APT C
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6340
Mailing Address - Country:US
Mailing Address - Phone:707-822-3899
Mailing Address - Fax:707-822-5115
Practice Address - Street 1:588 H ST APT C
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6340
Practice Address - Country:US
Practice Address - Phone:707-822-3899
Practice Address - Fax:707-822-5115
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19631106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist