=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073588497
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES JOSEPH MEADE PH. D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2412 N 30TH ST
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98407-6372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-752-7712
-----------------------------------------------------
Fax | 253-752-7712
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3620 N WASHINGTON ST
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98407-6149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-752-7712
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSY 1196
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------