Provider Demographics
NPI:1639182470
Name:O'BRYAN, MEGAN COLLEEN (PHD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:COLLEEN
Last Name:O'BRYAN
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9247 N MERIDIAN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1976
Mailing Address - Country:US
Mailing Address - Phone:317-843-1900
Mailing Address - Fax:317-843-1900
Practice Address - Street 1:9247 N MERIDIAN ST STE 202
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1976
Practice Address - Country:US
Practice Address - Phone:317-843-1900
Practice Address - Fax:317-843-1900
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041929A103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200502190Medicaid