Provider Demographics
NPI:1407740335
Name:MEEHAN, ANGELIQUE LORRAINE
Entity type:Individual
Prefix:MRS
First Name:ANGELIQUE
Middle Name:LORRAINE
Last Name:MEEHAN
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 1:10664 E TALLAHASSEE AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-8804
Mailing Address - Country:US
Mailing Address - Phone:602-410-4155
Mailing Address - Fax:
Practice Address - Street 1:10664 E TALLAHASSEE AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-8804
Practice Address - Country:US
Practice Address - Phone:602-410-4155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health