Provider Demographics
NPI:1831672351
Name:MIDDLEMISS, MEGAN LEE (MA, PC, ATR)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEE
Last Name:MIDDLEMISS
Suffix:
Gender:F
Credentials:MA, PC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1946 TOWN PARK BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8372
Mailing Address - Country:US
Mailing Address - Phone:330-896-5058
Mailing Address - Fax:330-896-5096
Practice Address - Street 1:1946 TOWN PARK BLVD STE 220
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-8372
Practice Address - Country:US
Practice Address - Phone:330-896-5058
Practice Address - Fax:330-896-5096
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1400063101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health