Provider Demographics
NPI:1144899972
Name:MEDLEY, MEAGAN (LP, NCSP)
Entity type:Individual
Prefix:DR
First Name:MEAGAN
Middle Name:
Last Name:MEDLEY
Suffix:
Gender:F
Credentials:LP, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 WESTERN GALES DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-8021
Mailing Address - Country:US
Mailing Address - Phone:504-812-6665
Mailing Address - Fax:
Practice Address - Street 1:104 E MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-3913
Practice Address - Country:US
Practice Address - Phone:662-205-0464
Practice Address - Fax:662-350-7107
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
AR202185103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool