Provider Demographics
NPI:1750886628
Name:JOHN, MEGAN M (LCPC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:JOHN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 AKENSIDE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1811
Mailing Address - Country:US
Mailing Address - Phone:708-421-5704
Mailing Address - Fax:
Practice Address - Street 1:522 W BURLINGTON AVE APT 4
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2134
Practice Address - Country:US
Practice Address - Phone:708-421-5704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-24
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010637101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty