Provider Demographics
NPI:1497415889
Name:BASGAL, MEAGAN MELISSA (CO61246259)
Entity Type:Individual
Prefix:MS
First Name:MEAGAN
Middle Name:MELISSA
Last Name:BASGAL
Suffix:
Gender:F
Credentials:CO61246259
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:305 PACIFIC AVE S STE C
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-1638
Mailing Address - Country:US
Mailing Address - Phone:360-425-5378
Mailing Address - Fax:360-425-5990
Practice Address - Street 1:305 PACIFIC AVE S STE C
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-1638
Practice Address - Country:US
Practice Address - Phone:360-425-5378
Practice Address - Fax:360-425-5990
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)