Provider Demographics
NPI:1669112264
Name:LABUTKA, MEGAN (LPC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:LABUTKA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:LYDIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 GREENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-8905
Mailing Address - Country:US
Mailing Address - Phone:724-599-6694
Mailing Address - Fax:
Practice Address - Street 1:1150 GRANT STREET
Practice Address - Street 2:#7
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701
Practice Address - Country:US
Practice Address - Phone:724-427-5648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1463088101Y00000X
PAPC015403101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor