Provider Demographics
NPI:1679537724
Name:MEADOR, CHRISTOPHER BLAINE (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:BLAINE
Last Name:MEADOR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 864047
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75086-4047
Mailing Address - Country:US
Mailing Address - Phone:214-674-8806
Mailing Address - Fax:
Practice Address - Street 1:3608 PRESTON RD
Practice Address - Street 2:STE 140
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8649
Practice Address - Country:US
Practice Address - Phone:214-674-8806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX063927001Medicaid
TX00958EMedicare ID - Type Unspecified
TX00958EMedicare UPIN
TX063927001Medicaid