Provider Demographics
NPI:1912328402
Name:MEEKS, TONYA LYN (LMFT)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:LYN
Last Name:MEEKS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14020 CAPTAINS ROW APT 205
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-7362
Mailing Address - Country:US
Mailing Address - Phone:415-571-0682
Mailing Address - Fax:
Practice Address - Street 1:180 NEWPORT CENTER DR STE 255
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-6987
Practice Address - Country:US
Practice Address - Phone:415-571-0682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53591106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist