Provider Demographics
NPI:1568135101
Name:MORRILL-RICHARDS, MANDY MEGGENS (LMHC , NCC)
Entity Type:Individual
Prefix:DR
First Name:MANDY
Middle Name:MEGGENS
Last Name:MORRILL-RICHARDS
Suffix:
Gender:F
Credentials:LMHC , NCC
Other - Prefix:DR
Other - First Name:MANDY
Other - Middle Name:MEGGENS
Other - Last Name:MORRILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC, NCC
Mailing Address - Street 1:711 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:IN
Mailing Address - Zip Code:46304-3174
Mailing Address - Country:US
Mailing Address - Phone:267-566-0880
Mailing Address - Fax:
Practice Address - Street 1:2801 BERTHOLET BLVD STE 301
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-7959
Practice Address - Country:US
Practice Address - Phone:219-323-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003401A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty