Provider Demographics
NPI:1073366845
Name:BROSH, MEGAN
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BROSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 554
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:CO
Mailing Address - Zip Code:81433-0554
Mailing Address - Country:US
Mailing Address - Phone:479-684-8221
Mailing Address - Fax:
Practice Address - Street 1:1315 SNOWDEN ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:CO
Practice Address - Zip Code:81433-5108
Practice Address - Country:US
Practice Address - Phone:970-387-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
ARA2011176101Y00000X
CO0019300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty