Provider Demographics
NPI:1619040680
Name:MEEKS, BRENDA (PHD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:MEEKS
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:PO BOX 3087
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79116-3087
Mailing Address - Country:US
Mailing Address - Phone:806-342-3500
Mailing Address - Fax:
Practice Address - Street 1:1216 S GEORGIA ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79102-1310
Practice Address - Country:US
Practice Address - Phone:806-342-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25791103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86140AOtherBLUE CROSS BLUE SHIELD
TX030950201Medicaid
TX030950201Medicaid