Provider Demographics
NPI:1649944588
Name:KELLY, MEGAN PAIGE (MA, LMHCA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:PAIGE
Last Name:KELLY
Suffix:
Gender:F
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3024
Mailing Address - Country:US
Mailing Address - Phone:612-442-2313
Mailing Address - Fax:
Practice Address - Street 1:9783 E 116TH ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-2822
Practice Address - Country:US
Practice Address - Phone:260-799-1447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88001149A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health