Provider Demographics
NPI:1740299262
Name:MERIDIAN PSYCHOLOGICAL CENTER PC
Entity type:Organization
Organization Name:MERIDIAN PSYCHOLOGICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:R
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ABPP
Authorized Official - Phone:208-855-0660
Mailing Address - Street 1:2770 E FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5953
Mailing Address - Country:US
Mailing Address - Phone:208-855-0660
Mailing Address - Fax:208-898-9433
Practice Address - Street 1:2770 E FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5953
Practice Address - Country:US
Practice Address - Phone:208-855-0660
Practice Address - Fax:208-898-9433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1681273Medicare PIN