Healthcare Provider Details

I. General information

NPI: 1225774599
Provider Name (Legal Business Name): MEREDITH J WACHTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 DEER VALLEY TRL NW
ALBUQUERQUE NM
87120-4383
US

IV. Provider business mailing address

1709 DEER VALLEY TRL NW
ALBUQUERQUE NM
87120-4383
US

V. Phone/Fax

Practice location:
  • Phone: 316-789-6089
  • Fax: 505-393-2366
Mailing address:
  • Phone: 316-789-6089
  • Fax: 505-393-2366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2024-0859
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCPC03894
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: