Provider Demographics
NPI:1700895893
Name:MEECH, JEFFERY THOMAS (PSYD)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:THOMAS
Last Name:MEECH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 W. SUNSET AVE
Mailing Address - Street 2:STE 15
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8366
Mailing Address - Country:US
Mailing Address - Phone:208-666-0357
Mailing Address - Fax:208-666-0468
Practice Address - Street 1:296 W. SUNSET AVE
Practice Address - Street 2:STE 15
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8366
Practice Address - Country:US
Practice Address - Phone:208-666-0357
Practice Address - Fax:208-666-0468
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-202532103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59647XMedicare ID - Type Unspecified