Provider Demographics
NPI:1841061256
Name:MERIDIAN WELLNESS SERVICES
Entity type:Organization
Organization Name:MERIDIAN WELLNESS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, DM
Authorized Official - Phone:970-568-2905
Mailing Address - Street 1:601 RED MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CO
Mailing Address - Zip Code:80536-8903
Mailing Address - Country:US
Mailing Address - Phone:970-568-2905
Mailing Address - Fax:
Practice Address - Street 1:601 RED MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CO
Practice Address - Zip Code:80536-8903
Practice Address - Country:US
Practice Address - Phone:970-568-2905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty