Individual
GLEN EDGAR MELDAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
2126 N 1ST STREET, SUITE F, JACKSONVILLE, AR 72076-2868
(501) 982-5000
(501) 982-5007
Mailing address
1815 PLEASANT GROVE RD, JONESBORO, AR 72401-7870
(870) 933-6886
(870) 933-9395
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
P9503006
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
187842795
—
AR
01
—
5T153
BCBS
AR
Enumeration date
08/09/2011
Last updated
11/10/2016
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