Provider Demographics
NPI:1871004671
Name:SOVA, MEGAN DOREEN (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:DOREEN
Last Name:SOVA
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4081 CASCADE RD SE STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2170
Mailing Address - Country:US
Mailing Address - Phone:616-957-3500
Mailing Address - Fax:616-957-3501
Practice Address - Street 1:4081 CASCADE RD SE STE A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2170
Practice Address - Country:US
Practice Address - Phone:616-965-6685
Practice Address - Fax:616-957-3501
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-19
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016368101YM0800X
MI4101006731106H00000X
MI6401018910101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist