Provider Demographics
NPI:1255510012
Name:GARRISON, MEG M (MA, LCPC, LMHC, NCC)
Entity type:Individual
Prefix:
First Name:MEG
Middle Name:M
Last Name:GARRISON
Suffix:
Gender:F
Credentials:MA, LCPC, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 NEWBURG RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-6436
Mailing Address - Country:US
Mailing Address - Phone:815-398-0500
Mailing Address - Fax:815-398-0588
Practice Address - Street 1:4215 NEWBURG RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-6479
Practice Address - Country:US
Practice Address - Phone:815-398-0500
Practice Address - Fax:815-398-0588
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007022101YP2500X
FLMH7298101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional