1508371782 NPI number — MEREDITH MECHENBIER TAIT LPCC

Table of content: NICOLAAS BUCHANAN (NPI 1770277659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508371782 NPI number — MEREDITH MECHENBIER TAIT LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAIT
Provider First Name:
MEREDITH
Provider Middle Name:
MECHENBIER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508371782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7200 FAIR OAKS BLVD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARMICHAEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95608-6454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-426-6009
Provider Business Mailing Address Fax Number:
916-426-6009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7200 FAIR OAKS BLVD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARMICHAEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95608-6454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-426-6009
Provider Business Practice Location Address Fax Number:
916-426-6009
Provider Enumeration Date:
12/09/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LPCC-4052 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)