Provider Demographics
NPI:1437438900
Name:MENG, KARL NATHAN (PHD, LMFT)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:NATHAN
Last Name:MENG
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 E BAMBERGER DR STE C
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2183
Mailing Address - Country:US
Mailing Address - Phone:385-269-0371
Mailing Address - Fax:
Practice Address - Street 1:789 E BAMBERGER DR STE C
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2183
Practice Address - Country:US
Practice Address - Phone:385-269-0371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT61837403902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist