Healthcare Provider Details

I. General information

NPI: 1497686414
Provider Name (Legal Business Name): MERIDIAN THERAPY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 E 10TH ST APT 302
INDIANAPOLIS IN
46202-3834
US

IV. Provider business mailing address

622 E 10TH ST APT 302
INDIANAPOLIS IN
46202-3834
US

V. Phone/Fax

Practice location:
  • Phone: 310-689-6470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN MOONEY
Title or Position: CEO
Credential:
Phone: 310-689-6470