Provider Demographics
NPI:1295206894
Name:MCCAULEY, MEREDITH PAIGE
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:PAIGE
Last Name:MCCAULEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 LAKE FOREST PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-4665
Mailing Address - Country:US
Mailing Address - Phone:502-681-2159
Mailing Address - Fax:
Practice Address - Street 1:207 NATIONAL DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-6860
Practice Address - Country:US
Practice Address - Phone:615-898-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-08
Last Update Date:2018-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-18-53022103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYYRP955M64650OtherBLUE CROSS BLUE SHIELD