Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003196775 |
---|---|
Provider Name | Ms. Lisa Jean Meredith |
First Address | Grants Pass, OR 97526-2544 |
Second Address | Grants Pass, OR 97526-2544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2011 |
Last Update Date | 25/08/2011 |