Provider Demographics
NPI:1598482192
Name:STUART, MEGAN DIANA
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:DIANA
Last Name:STUART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 TELLER AVE APT 45
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3253
Mailing Address - Country:US
Mailing Address - Phone:480-820-0256
Mailing Address - Fax:
Practice Address - Street 1:1130 BELFORD AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3137
Practice Address - Country:US
Practice Address - Phone:480-820-0256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health