Provider Demographics
NPI:1720430820
Name:WILLIAMS, MEGAN (LCSW)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:MT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-7757
Mailing Address - Country:US
Mailing Address - Phone:502-538-1000
Mailing Address - Fax:502-538-1100
Practice Address - Street 1:1925 FREDERICA ST STE 200
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-4818
Practice Address - Country:US
Practice Address - Phone:270-926-2484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY77051041C0700X
KY2541081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100597410Medicaid