Provider Demographics
NPI:1265703565
Name:MAHOUM-NASSAR, MEGHAN D (LMHC)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:D
Last Name:MAHOUM-NASSAR
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:D
Other - Last Name:MCINTOSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:PO BOX 18984
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33679-8984
Mailing Address - Country:US
Mailing Address - Phone:813-368-1829
Mailing Address - Fax:
Practice Address - Street 1:730 S STERLING AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4542
Practice Address - Country:US
Practice Address - Phone:813-474-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11238101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional