Provider Demographics
NPI:1508193343
Name:MEAGHER, STEPHANIE (MA MFT)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:MEAGHER
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10130 SW NIMBUS AVE
Mailing Address - Street 2:STE. D3
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-4335
Mailing Address - Country:US
Mailing Address - Phone:503-597-5521
Mailing Address - Fax:
Practice Address - Street 1:10130 SW NIMBUS AVE
Practice Address - Street 2:STE. D3
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-4335
Practice Address - Country:US
Practice Address - Phone:503-597-5521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR1750101YM0800X
ORR1745106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health