Provider Demographics
NPI:1437404712
Name:MCQUILLAN, MEGGAN MCGRATH (LMFT)
Entity Type:Individual
Prefix:
First Name:MEGGAN
Middle Name:MCGRATH
Last Name:MCQUILLAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 SAINT PAUL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-2019
Mailing Address - Country:US
Mailing Address - Phone:651-366-9760
Mailing Address - Fax:
Practice Address - Street 1:7493 147TH ST W
Practice Address - Street 2:107
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-4505
Practice Address - Country:US
Practice Address - Phone:651-366-9760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2021106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist