Provider Demographics
NPI:1033577309
Name:CINNAMON, MEGAN RENAE (LPCC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:RENAE
Last Name:CINNAMON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:RENAE
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MEGAN R SIMPSON
Mailing Address - Street 1:600 CLIFTY ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-1710
Mailing Address - Country:US
Mailing Address - Phone:606-678-0026
Mailing Address - Fax:606-678-0047
Practice Address - Street 1:600 CLIFTY ST STE 2
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503
Practice Address - Country:US
Practice Address - Phone:606-678-0026
Practice Address - Fax:606-678-0047
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCCCA00224172101YM0800X
KY245273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100571920Medicaid