Provider Demographics
NPI:1790194199
Name:MOLLER, MEAGAN (MA, ATR, LCPC, LMHC)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:MOLLER
Suffix:
Gender:F
Credentials:MA, ATR, LCPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-4053
Mailing Address - Country:US
Mailing Address - Phone:563-447-5655
Mailing Address - Fax:
Practice Address - Street 1:102 E 2ND ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52801-1502
Practice Address - Country:US
Practice Address - Phone:563-447-5655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008577101YP2500X
IA075366101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional