Provider Demographics
NPI:1710492467
Name:CLOUGH, MEGAN FORD (BEHAVIOR ANALYST)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:FORD
Last Name:CLOUGH
Suffix:
Gender:F
Credentials:BEHAVIOR ANALYST
Other - Prefix:MRS
Other - First Name:MEGAN
Other - Middle Name:FORD
Other - Last Name:PETITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BEHAVIOR ANALYST
Mailing Address - Street 1:1050 FORREST AVE
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901
Mailing Address - Country:US
Mailing Address - Phone:256-459-5499
Mailing Address - Fax:256-907-5155
Practice Address - Street 1:1050 FORREST AVE
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901
Practice Address - Country:US
Practice Address - Phone:256-459-5499
Practice Address - Fax:256-907-5155
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-04
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2017-024103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL280022Medicaid