Provider Demographics
NPI:1790271179
Name:CRITTENDEN, MEGAN (MA, LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:CRITTENDEN
Suffix:
Gender:F
Credentials:MA, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 KENILWORTH PL
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-2324
Mailing Address - Country:US
Mailing Address - Phone:650-796-4883
Mailing Address - Fax:
Practice Address - Street 1:2909 WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-2126
Practice Address - Country:US
Practice Address - Phone:763-999-7920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48956106H00000X
ID3623101YP2500X
MN02010101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist