Healthcare Provider Details

I. General information

NPI: 1760608939
Provider Name (Legal Business Name): MISS LYNNE ANN MERIDITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 S MADERA AVE STE H
MADERA CA
93637-5462
US

IV. Provider business mailing address

450 S MADERA AVE STE H
MADERA CA
93637-5462
US

V. Phone/Fax

Practice location:
  • Phone: 559-675-4515
  • Fax: 559-675-7978
Mailing address:
  • Phone: 559-675-4515
  • Fax: 559-675-7978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: