Provider Demographics
NPI:1639526098
Name:WILLES, MEGAN (PLMHP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:WILLES
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13460 WALSH DR
Mailing Address - Street 2:
Mailing Address - City:BOYS TOWN
Mailing Address - State:NE
Mailing Address - Zip Code:68010-7529
Mailing Address - Country:US
Mailing Address - Phone:402-498-3358
Mailing Address - Fax:402-498-3375
Practice Address - Street 1:13460 WALSH DR
Practice Address - Street 2:
Practice Address - City:BOYS TOWN
Practice Address - State:NE
Practice Address - Zip Code:68010-7529
Practice Address - Country:US
Practice Address - Phone:402-498-3358
Practice Address - Fax:402-498-3375
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10858101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor