Provider Demographics
NPI:1861163131
Name:PUCKETT, MEREDITH B (LMFTA)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:B
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:MRS
Other - First Name:MEREDITH
Other - Middle Name:PUCKETT
Other - Last Name:FEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFTA
Mailing Address - Street 1:212 WHITSETT ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3141
Mailing Address - Country:US
Mailing Address - Phone:864-608-0314
Mailing Address - Fax:
Practice Address - Street 1:212 WHITSETT ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3141
Practice Address - Country:US
Practice Address - Phone:864-608-0314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-25
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7739106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist