Provider Demographics
NPI:1356079081
Name:SAMPLE, MEGAN (MHCA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:SAMPLE
Suffix:
Gender:F
Credentials:MHCA
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:H
Other - Last Name:SAMPLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MHCA
Mailing Address - Street 1:100 N HOWARD ST STE 4891
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0508
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:61 DUFFIELD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-2009
Practice Address - Country:US
Practice Address - Phone:603-703-4370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61337227101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health