Provider Demographics
NPI:1386499812
Name:MELDRUM, ANNA MARIE
Entity type:Individual
Prefix:
First Name:ANNA MARIE
Middle Name:
Last Name:MELDRUM
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 1:16117 KIVA CT
Mailing Address - Street 2:
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247-6725
Mailing Address - Country:US
Mailing Address - Phone:682-386-7219
Mailing Address - Fax:
Practice Address - Street 1:4541 N BENTWOOD DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-8229
Practice Address - Country:US
Practice Address - Phone:325-939-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician