Provider Demographics
NPI:1992398960
Name:TREZIOK, MEGAN ELIZABETH (MPS, LADC, LPCC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:TREZIOK
Suffix:
Gender:F
Credentials:MPS, LADC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 GOTZIAN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-5333
Mailing Address - Country:US
Mailing Address - Phone:612-237-4767
Mailing Address - Fax:
Practice Address - Street 1:701 4TH AVE S STE 1500
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1637
Practice Address - Country:US
Practice Address - Phone:612-373-9164
Practice Address - Fax:612-373-2470
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305820101YA0400X
101YM0800X
MN03895101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty