Provider Demographics
NPI:1821494881
Name:COLLEY, MEGHAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:
Last Name:COLLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3880
Mailing Address - Country:US
Mailing Address - Phone:574-267-7169
Mailing Address - Fax:574-269-4189
Practice Address - Street 1:2860 NORTHPARK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-9700
Practice Address - Country:US
Practice Address - Phone:260-356-2875
Practice Address - Fax:260-358-0611
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042752A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical