Provider Demographics
NPI:1417425083
Name:FAITH, MEREDITH LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:LYNN
Last Name:FAITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 ELVIN AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-3231
Mailing Address - Country:US
Mailing Address - Phone:505-850-7845
Mailing Address - Fax:
Practice Address - Street 1:11109 ELVIN AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-3231
Practice Address - Country:US
Practice Address - Phone:505-850-7845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0947103T00000X
NM294802103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103T00000XBehavioral Health & Social Service ProvidersPsychologist