Provider Demographics
NPI:1043427511
Name:FOREMAN, MEGAN LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LYNN
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 W VICKERY BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6256
Mailing Address - Country:US
Mailing Address - Phone:817-720-0382
Mailing Address - Fax:
Practice Address - Street 1:4410 W VICKERY BLVD STE 204
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6256
Practice Address - Country:US
Practice Address - Phone:817-720-0382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009446411041C0700X
225C00000X
TX1076801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor