Provider Demographics
NPI:1336871201
Name:ALT, MEREDITH (EDS, NCSP)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:ALT
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:
Other - Last Name:REMME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS, NCSP
Mailing Address - Street 1:4203 WILKINSON AVE
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-1662
Mailing Address - Country:US
Mailing Address - Phone:206-271-9951
Mailing Address - Fax:
Practice Address - Street 1:4203 WILKINSON AVE
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-1662
Practice Address - Country:US
Practice Address - Phone:206-271-9951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool