Provider Demographics
NPI:1518013309
Name:THOMAS, MEGAN GREGG (PHD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:GREGG
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 EDILYN CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2527
Mailing Address - Country:US
Mailing Address - Phone:614-464-6807
Mailing Address - Fax:614-895-9807
Practice Address - Street 1:3400 KENNY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-1500
Practice Address - Country:US
Practice Address - Phone:614-464-6807
Practice Address - Fax:614-895-9807
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5411103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2086602Medicaid
OHGRCP21642Medicare ID - Type Unspecified