Provider Demographics
NPI:1447486139
Name:MEABROD, KARL DAVID (CAODC)
Entity type:Individual
Prefix:MR
First Name:KARL
Middle Name:DAVID
Last Name:MEABROD
Suffix:
Gender:M
Credentials:CAODC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 BELLEVUE CT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0518
Mailing Address - Country:US
Mailing Address - Phone:209-614-0146
Mailing Address - Fax:209-409-8836
Practice Address - Street 1:190 E. HACKETT RD.
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358
Practice Address - Country:US
Practice Address - Phone:209-996-7210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA02-049232101YA0400X, 101YM0800X, 171M00000X
CA5636101YA0400X, 101YM0800X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA02-049232OtherCALIFORNIA CONSORTIUM OF ADDICTION PROGRAMS AND PROFESSIONALS
CA5636OtherCALIFORNIA ASSOCIATION OF DUI TREATMENT PROGRAMS