Provider Demographics
NPI:1225774599
Name:WACHTER, MEREDITH J
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:J
Last Name:WACHTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 W PANCAKE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-4008
Mailing Address - Country:US
Mailing Address - Phone:316-789-6089
Mailing Address - Fax:
Practice Address - Street 1:239 W PANCAKE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-4008
Practice Address - Country:US
Practice Address - Phone:316-789-6089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2024-0859101YP2500X
KSLCPC03894101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional