Organization Name: | MEADOWLARK PSYCHIATRIC SERVICES |
NPI Number: | 1023141330 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARTIN WALLACE CARPENTER (MD, OWNER, PRESIDENT) |
Mailing Address: | 320 West Cherry Street North Liberty |
State: | IA US |
Postal Code: | 52317 |
Phone Number: | 3196263300 |
Fax Number: | 3196263084 |
NPI Enumeration Date: | 03/14/2007 |
NPI Last Update Date: | 10/25/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |