Provider Demographics
NPI:1205482379
Name:ESCUTIA, MEGAN (LPC, LCPC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:ESCUTIA
Suffix:
Gender:F
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 TENNYSON ST UNIT 12451
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-4418
Mailing Address - Country:US
Mailing Address - Phone:312-487-1179
Mailing Address - Fax:
Practice Address - Street 1:159 N SANGAMON ST STE 200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2201
Practice Address - Country:US
Practice Address - Phone:312-487-1179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.012600101YM0800X
IL180.012302101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1225377294OtherCENTER FOR BEHAVIORAL MEDICINE, LTD