Provider Demographics
NPI:1215042148
Name:MEINEN, SALLIE S (LPC)
Entity type:Individual
Prefix:MRS
First Name:SALLIE
Middle Name:S
Last Name:MEINEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 RIVER RUN
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6579
Mailing Address - Country:US
Mailing Address - Phone:817-204-0162
Mailing Address - Fax:817-336-1740
Practice Address - Street 1:1701 RIVER RUN
Practice Address - Street 2:SUITE 1002
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6579
Practice Address - Country:US
Practice Address - Phone:817-204-0162
Practice Address - Fax:817-336-1740
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20072101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1793275Medicaid