Provider Demographics
NPI:1386818979
Name:MERIDIAN PSYCHOLOGICAL SERVICES, INC
Entity Type:Organization
Organization Name:MERIDIAN PSYCHOLOGICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-450-5045
Mailing Address - Street 1:9400 GOLDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4318
Mailing Address - Country:US
Mailing Address - Phone:763-450-5000
Mailing Address - Fax:
Practice Address - Street 1:9400 GOLDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4318
Practice Address - Country:US
Practice Address - Phone:763-450-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN477848100Medicaid
MNC04232Medicare PIN