Provider Demographics
NPI:1598132334
Name:MCCORMICK, MEGAN (LMFT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 W 3RD ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-1212
Mailing Address - Country:US
Mailing Address - Phone:316-660-7600
Mailing Address - Fax:316-941-5075
Practice Address - Street 1:350 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-4304
Practice Address - Country:US
Practice Address - Phone:316-660-9600
Practice Address - Fax:316-660-9660
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-2686106H00000X
KS2783106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist