Healthcare Provider Details

I. General information

NPI: 1891601373
Provider Name (Legal Business Name): GREGORY MEEKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1636 SHADY BROOK DR
FULLERTON CA
92831-1877
US

IV. Provider business mailing address

1636 SHADY BROOK DR
FULLERTON CA
92831-1877
US

V. Phone/Fax

Practice location:
  • Phone: 949-233-3474
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number137956
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: