Provider Demographics
NPI:1114553757
Name:NANCE, MEGAN (LMHC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:NANCE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MEGGIE
Other - Middle Name:
Other - Last Name:NANCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:1048 CLEARVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5810
Mailing Address - Country:US
Mailing Address - Phone:863-670-6854
Mailing Address - Fax:
Practice Address - Street 1:50 LAKE MORTON DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5343
Practice Address - Country:US
Practice Address - Phone:863-670-6854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17834101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17834OtherFLORIDA DEPARTMENT OF HEALTH