Provider Demographics
NPI:1942363940
Name:KLEIN-TRULL, MEG ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MEG
Middle Name:ANNE
Last Name:KLEIN-TRULL
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 1:2416 RIDGEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-1532
Mailing Address - Country:US
Mailing Address - Phone:573-445-3554
Mailing Address - Fax:
Practice Address - Street 1:PSYCHOLOGICAL SERVICES CLINIC
Practice Address - Street 2:211 S. 8TH ST.
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65211-0001
Practice Address - Country:US
Practice Address - Phone:573-882-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01480103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO112296Medicare UPIN