Provider Demographics
NPI:1497966964
Name:MEREDITH, ALISSA CAWLEY (MFT)
Entity Type:Individual
Prefix:MS
First Name:ALISSA
Middle Name:CAWLEY
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 CORTE RAQUEL
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-7320
Mailing Address - Country:US
Mailing Address - Phone:760-216-6269
Mailing Address - Fax:
Practice Address - Street 1:672 CORTE RAQUEL
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-7320
Practice Address - Country:US
Practice Address - Phone:760-216-6269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35752106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist