Provider Demographics
NPI:1497559017
Name:ROSS, MEGAN (PHD, LCPC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:PHD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 S FLEMING RD
Mailing Address - Street 2:
Mailing Address - City:BULL VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60098-7908
Mailing Address - Country:US
Mailing Address - Phone:773-255-1884
Mailing Address - Fax:
Practice Address - Street 1:1112 S FLEMING RD
Practice Address - Street 2:
Practice Address - City:BULL VALLEY
Practice Address - State:IL
Practice Address - Zip Code:60098-7908
Practice Address - Country:US
Practice Address - Phone:773-255-1884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180013342101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health