1912338419 NPI number — UNIVERSITY OF DENVER PROFESSIONAL PSYCHOLOGY CLININ

Table of content: RAYNARD D. MERIDITH MA, LPC, NCC (NPI 1518224054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912338419 NPI number — UNIVERSITY OF DENVER PROFESSIONAL PSYCHOLOGY CLININ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF DENVER PROFESSIONAL PSYCHOLOGY CLININ
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912338419
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2450 S. VINE ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2450 S VINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80210-5264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-871-3988
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LUGUBUIN
Authorized Official First Name:
FERNAND
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINIC DIRECTOR
Authorized Official Telephone Number:
303-871-3988

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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