Provider Demographics
NPI:1134995731
Name:VANAMBURG, MEGAN EMILY
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:EMILY
Last Name:VANAMBURG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 N MOUNT JULIET RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-4498
Mailing Address - Country:US
Mailing Address - Phone:615-438-3615
Mailing Address - Fax:
Practice Address - Street 1:1222 MURRAY CT
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-5630
Practice Address - Country:US
Practice Address - Phone:256-777-2895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health