Healthcare Provider Details

I. General information

NPI: 1669677951
Provider Name (Legal Business Name): TERESA MEISENHALDER PSYCHOMETRIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 08/15/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2739T ROOSEVELT DR BLDG H201-T
CAMP PENDLETON CA
92055-5657
US

IV. Provider business mailing address

PO BOX 555657 1ST MEDICAL BATTALION, 22 GAS
CAMP PENDLETON CA
92055-5657
US

V. Phone/Fax

Practice location:
  • Phone: 519-514-8294
  • Fax:
Mailing address:
  • Phone: 760-725-4912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: