Provider Demographics
NPI:1639182470
Name:O'BRYAN, MEGAN COLLEEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:COLLEEN
Last Name:O'BRYAN
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 1:210 E 91ST ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1569
Mailing Address - Country:US
Mailing Address - Phone:317-844-0055
Mailing Address - Fax:317-571-5040
Practice Address - Street 1:210 E 91ST ST
Practice Address - Street 2:SUITE C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1569
Practice Address - Country:US
Practice Address - Phone:317-844-0055
Practice Address - Fax:317-571-5040
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041929A103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q23596Medicare UPIN