Provider Demographics
NPI:1407431166
Name:MATES, MEREDITH JEAN (BCBA)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:JEAN
Last Name:MATES
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7642 COUNTY HIGHWAY 97
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:OH
Mailing Address - Zip Code:43359-9740
Mailing Address - Country:US
Mailing Address - Phone:419-310-1719
Mailing Address - Fax:
Practice Address - Street 1:7642 COUNTY HIGHWAY 97
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:OH
Practice Address - Zip Code:43359-9740
Practice Address - Country:US
Practice Address - Phone:419-310-1719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-13-12780103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst