Provider Demographics
NPI:1790999894
Name:MEREDITH, LISA (MBS, LPC, LADC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:MBS, LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 LYNN LN
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-6845
Mailing Address - Country:US
Mailing Address - Phone:580-286-7025
Mailing Address - Fax:580-286-7436
Practice Address - Street 1:1303 LYNN LN
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-6845
Practice Address - Country:US
Practice Address - Phone:580-286-7025
Practice Address - Fax:580-286-7436
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional