Provider Demographics
NPI:1154065464
Name:HLAVAC, MEGAN KELLEY CARR
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:KELLEY CARR
Last Name:HLAVAC
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 1:1588 ELMBROOK TRL
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-9722
Mailing Address - Country:US
Mailing Address - Phone:513-227-1628
Mailing Address - Fax:
Practice Address - Street 1:1588 ELMBROOK TRL
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-9722
Practice Address - Country:US
Practice Address - Phone:513-227-1628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0900261101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional