Healthcare Provider Details

I. General information

NPI: 1851179287
Provider Name (Legal Business Name): MERIDIEM PSYCHOLOGICAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 1/2 N MARKET ST
BENTON AR
72015-3768
US

IV. Provider business mailing address

125 1/2 N MARKET ST
BENTON AR
72015-3768
US

V. Phone/Fax

Practice location:
  • Phone: 501-765-9525
  • Fax: 501-745-2378
Mailing address:
  • Phone: 501-765-9525
  • Fax: 501-745-2378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ROSEMARY BURNS
Title or Position: LPE-I
Credential:
Phone: 501-765-9525