Provider Demographics
NPI:1700177631
Name:MARCUM, MEAGAN ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MEAGAN
Middle Name:ELIZABETH
Last Name:MARCUM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 PARK PLAZA AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2236
Mailing Address - Country:US
Mailing Address - Phone:502-429-5431
Mailing Address - Fax:502-429-5439
Practice Address - Street 1:9700 PARK PLAZA AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2236
Practice Address - Country:US
Practice Address - Phone:502-429-5431
Practice Address - Fax:502-429-5439
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1631103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist