Provider Demographics
NPI:1164468609
Name:MEHARG, STEPHEN SCOTT (PHD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:SCOTT
Last Name:MEHARG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 11TH AVE
Mailing Address - Street 2:STE B
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2555
Mailing Address - Country:US
Mailing Address - Phone:360-414-8600
Mailing Address - Fax:360-636-7372
Practice Address - Street 1:945 11TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2503
Practice Address - Country:US
Practice Address - Phone:360-414-8600
Practice Address - Fax:360-636-7372
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001656103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7096274Medicaid
WA7096274Medicaid