Provider Demographics
NPI:1245806207
Name:PORSCH, MEGEAN
Entity Type:Individual
Prefix:
First Name:MEGEAN
Middle Name:
Last Name:PORSCH
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 1:6909 BAY GLADWIN COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:BENTLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48613-9710
Mailing Address - Country:US
Mailing Address - Phone:989-903-9250
Mailing Address - Fax:
Practice Address - Street 1:6909 BAY GLADWIN COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:BENTLEY
Practice Address - State:MI
Practice Address - Zip Code:48613-9710
Practice Address - Country:US
Practice Address - Phone:989-903-9250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst