Basic Information
| Provider Information | |||||||||
| NPI: | 1548279615 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JEFFERY T. MEECH, PSYD, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 296 W. SUNSET AVE | ||||||||
| Address2: | STE 15 | ||||||||
| City: | COEUR D'ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838158366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086660357 | ||||||||
| FaxNumber: | 2086660468 | ||||||||
| Practice Location | |||||||||
| Address1: | 296 W. SUNSET AVE | ||||||||
| Address2: | STE 15 | ||||||||
| City: | COEUR D'ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838158366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086660357 | ||||||||
| FaxNumber: | 2086660468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2006 | ||||||||
| LastUpdateDate: | 09/19/2019 | ||||||||
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| AuthorizedOfficialLastName: | MEECH | ||||||||
| AuthorizedOfficialFirstName: | JEFFERY | ||||||||
| AuthorizedOfficialMiddleName: | THOMAS | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 2086660357 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSY.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PY5143 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.