GLEN EDGAR MELDAHL (NPI# 1790064624) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790064624 |
| Entity Type | Individual |
| Full Name | GLEN EDGAR MELDAHL |
| Credential | LPC |
| Practice Address |
2126 N 1st Street Suite F Jacksonville AR 72076-2868 |
| Mailing Address |
1815 Pleasant Grove Rd Jonesboro AR 72401-7870 |
| Practice Telephone | 5019825000 |
| Practice Fax Number | 5019825007 |
| Mailing Telephone | 8709336886 |
| Mailing Fax Number | 8709339395 |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2016-11-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
P9503006 | AR | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 187842795 | 05 | |
| AR | BCBS | 5T153 | 01 |
| Street Address |
2126 N 1ST STREET SUITE F |
| City | JACKSONVILLE |
| State | AR |
| Zip Code | 72076-2868 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346360245 | Ashli Nicole Jones-williams | Counselor | 2126 N 1st Street, Suite F, Jacksonville, AR 72076-2868 | 2007-04-02 |
| 1629696984 | Hailey Marie Washam | Social Worker | 2126 N 1st Street, Suite F, Jacksonville, AR 72076-2868 | 2020-07-13 |
| 1336762855 | Alyson Rachelle Walker | Counselor | 2126 N 1st Street, Suite F, Jacksonville, AR 72076-2868 | 2020-05-19 |
| 1215468251 | Amy Louise Belew | Case Manager/Care Coordinator | 2126 N 1st Street, Suite F, Jacksonville, AR 72076 | 2017-03-22 |
| 1699219295 | Lindsey Mills | Counselor | 2126 N 1st Street, Suite F, Jacksonville, AR 72076-2868 | 2016-12-15 |
| 1952853723 | Shannon Marie Overcash | Counselor | 2126 N 1st Street, Suite F, Jacksonville, AR 72076-2868 | 2016-10-27 |
| 1962951475 | Haylie Brianne Hart | Case Manager/Care Coordinator | 2126 N 1st Street, Suite F, Jacksonville, AR 72076-2868 | 2016-09-26 |
| 1801251947 | Monique Shavonne Summons | Case Manager/Care Coordinator | 2126 N 1st Street, Suite F, Jacksonville, AR 72076-2868 | 2015-12-16 |
| 1134595473 | Colleen Diane Schwesinger | Counselor | 2126 N 1st Street, Suite F, Jacksonville, AR 72076-7870 | 2015-08-20 |
| 1710370069 | Alicia Marie Baros | Nurse Practitioner | 2126 N 1st Street, Suite F, Jacksonville, AR 72076-2868 | 2015-03-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598396046 | Jennifer Michelle Price | Licensed Practical Nurse | 2400 West Main, Jacksonville, AR 72076 | 2020-02-03 |
| 1912464009 | Stat Home Health - Cenark LLC | Home Health | 1410 Braden Street, Jacksonville, AR 72076 | 2019-02-25 |
| 1649797671 | Caring Hearts Counseling, LLC | Case Management | 111 Marble Drive, Jacksonville, AR 72076 | 2017-08-30 |
| 1376071340 | Anne Elizabeth Houtchens | Speech-Language Pathologist | 2701 Tp White Drive, Jacksonville, AR 72076 | 2017-06-02 |
| 1881140648 | Jacksonville North Pulaski School District | Local Education Agency (LEA) | 1414 West Main, Jacksonville, AR 72076 | 2016-08-31 |
| 1134599772 | Jeremiah Melson Fleeman | Occupational Therapist | 2701 Tpwhite Drive, Jacksonville, AR 72076 | 2015-09-25 |
| 1821424565 | Kasey Michele Leeson | Social Worker | 2520 W. Main St., Jacksonville, AR 72076 | 2013-09-25 |
| 1407104052 | Cesalie Deonne Wallace | Nurse Practitioner | 3000 North First Street, Jacksonville, AR 72076 | 2012-08-29 |
| 1952660995 | Joshua Aaron Hill | Case Manager/Care Coordinator | 2126 N. 1st St Suite F, Jacksonville, AR 72076 | 2012-05-11 |
| 1396023156 | Syreeta Tucker | Case Manager/Care Coordinator | 1109 Burman, Jacksonville, AR 72076 | 2011-07-28 |
| Find all providers in zip 72076 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134720519 | Ashley Harms | Counselor | 4070 Herschel St Ste 1, Jacksonville, FL 32210-2239 | 2020-11-03 |
| 1902418684 | Molly Ann Burkhardt | Counselor | 5776 Saint Augustine Rd # 8030, Jacksonville, FL 32207-8046 | 2020-08-23 |
| 1194335638 | Aiteria Green | Counselor | 9713 Bridgeway Ave, Jacksonville, FL 32222-2913 | 2020-08-07 |
| 1053920116 | Barbara Burden | Counselor | 209 N Carole Dr, Jacksonville, NC 28546-4845 | 2020-07-24 |
| 1790393973 | Kelley Holladay | Counselor | 1782 Plantation Oaks Dr, Jacksonville, FL 32223-5010 | 2020-07-14 |
| 1629696646 | Mary Ann Caldwell | Counselor | 2496 Northwoods Dr., Jacksonville, NC 28540 | 2020-07-07 |
| 1447877709 | Quendria Johnson-kerns | Counselor | 200 Zonnie Ln, Jacksonville, NC 28540-9729 | 2020-07-02 |
| 1467077164 | Shanna Horan | Counselor | 13500 Sutton Park Dr S Ste 702, Jacksonville, FL 32224-5290 | 2020-06-09 |
| 1720602527 | Shannon E Raikes | Counselor | 13990 Bartram Park Blvd Unit 209, Jacksonville, FL 32258-5543 | 2020-06-08 |
| 1750905253 | Kathlena N Reed | Counselor | 4131 University Blvd S Fl 32216, Jacksonville, FL 32216-4326 | 2020-06-01 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 72076 |
Please comment or provide details below to improve the information on GLEN EDGAR MELDAHL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.