Provider Demographics
NPI:1356795223
Name:ATER, MEREDITH (MED, LPC)
Entity type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:
Last Name:ATER
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 LISBON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5673
Mailing Address - Country:US
Mailing Address - Phone:817-738-4660
Mailing Address - Fax:
Practice Address - Street 1:3815 LISBON ST STE 202
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5673
Practice Address - Country:US
Practice Address - Phone:817-738-4660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16438101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health