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General NPI Number Information
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NPI Number | 1144899972
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Entity Type | Individual
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Provider Name | MEAGAN MEDLEY LP, NCSP
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Gender | Female
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Dates
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Enumeration Date | 06/24/2021
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 104 E MAIN ST STE E
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City | NEW ALBANY
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State | MS
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Zip | 38652-3913
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Country | US
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Telephone | 662-205-0464
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Fax | 662-350-7107
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Provider Business Mailing Address
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Address Line | 3420 WESTERN GALES DR
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City | JONESBORO
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State | AR
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Zip | 72405-8021
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Country | US
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Telephone | 504-812-6665
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 202185
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License Number State | AR
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