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NPI 1962421693

NPI 1962421693 : JAMES MEREDITH PHD : SAN ANTONIO, TX

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General NPI Number Information
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    NPI Number           |    1962421693
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    Entity Type          |    Individual 
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    Provider Name        |    JAMES MEREDITH PHD
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    07/19/2006
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    Last Update Date     |    07/08/2007
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Provider Practice Location Address
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    Address Line         |    4230 LUCKENBACH RD 
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    City                 |    SAN ANTONIO
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    State                |    TX
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    Zip                  |    78251-4306
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    Country              |    US
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    Telephone            |    210-520-7607
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    4230 LUCKENBACH RD 
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    City                 |    SAN ANTONIO
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    State                |    TX
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    Zip                  |    78251-4306
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    Country              |    US
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    Telephone            |    210-520-7607
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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        |    103TC0700X
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    Taxonomy Name        |    Clinical Psychologist
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    License Number       |    32685
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    License Number State |    TX
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