Provider Demographics
NPI:1467533281
Name:HAVELKA, MEGGAN K (LPC)
Entity Type:Individual
Prefix:
First Name:MEGGAN
Middle Name:K
Last Name:HAVELKA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 N MAIN ST STE 425
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-9216
Mailing Address - Country:US
Mailing Address - Phone:214-724-3571
Mailing Address - Fax:
Practice Address - Street 1:621 N MAIN ST STE 425
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-9216
Practice Address - Country:US
Practice Address - Phone:214-724-3571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18540101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84819LOtherBCBS
TX10033301OtherAMERIGROUP PROVIDER NUMBE
TX164489003Medicaid