Provider Demographics
NPI:1184485534
Name:MEGAN RICHERT, LICENSED CLINICAL SOCIAL WORKER, INC
Entity type:Organization
Organization Name:MEGAN RICHERT, LICENSED CLINICAL SOCIAL WORKER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:RICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:805-774-0656
Mailing Address - Street 1:310 JAMES WAY STE 150
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-2877
Mailing Address - Country:US
Mailing Address - Phone:805-774-0656
Mailing Address - Fax:
Practice Address - Street 1:310 JAMES WAY STE 150
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-2877
Practice Address - Country:US
Practice Address - Phone:805-774-0656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health