Provider Demographics
NPI:1982197679
Name:VAN TINE, MEREDITH (PSYD, JD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:
Last Name:VAN TINE
Suffix:
Gender:F
Credentials:PSYD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7527 E 1ST ST STE 8
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-4501
Mailing Address - Country:US
Mailing Address - Phone:480-773-6717
Mailing Address - Fax:
Practice Address - Street 1:7527 E 1ST ST STE 8
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-4501
Practice Address - Country:US
Practice Address - Phone:480-773-6717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-004958103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical