Provider Demographics
NPI:1245581313
Name:CARLSON, MEGAN L (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:L
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1818
Mailing Address - Country:US
Mailing Address - Phone:484-402-6673
Mailing Address - Fax:
Practice Address - Street 1:491 JOHN YOUNG WAY STE 300
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2567
Practice Address - Country:US
Practice Address - Phone:610-644-6464
Practice Address - Fax:610-889-0732
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006425101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional