Provider Demographics
NPI:1467750802
Name:HEEDER-MEGAN, MEGAN TARA (LMHC)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:TARA
Last Name:HEEDER-MEGAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 MOOSE RIVER COMMONS LOOP
Mailing Address - Street 2:PO BOX 911
Mailing Address - City:OLD FORGE
Mailing Address - State:NY
Mailing Address - Zip Code:13420
Mailing Address - Country:US
Mailing Address - Phone:518-928-8192
Mailing Address - Fax:
Practice Address - Street 1:3002 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD FORGE
Practice Address - State:NY
Practice Address - Zip Code:13420
Practice Address - Country:US
Practice Address - Phone:315-272-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680065303101YM0800X
NY007095-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health