Provider Demographics
NPI:1780342303
Name:MCMICHAEL, MEGHAN PHILLIPS (RMHCI, MRC, CRC)
Entity type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:PHILLIPS
Last Name:MCMICHAEL
Suffix:
Gender:F
Credentials:RMHCI, MRC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 SOUTH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-7892
Mailing Address - Country:US
Mailing Address - Phone:973-525-5426
Mailing Address - Fax:
Practice Address - Street 1:1600 SARNO RD STE 117
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4992
Practice Address - Country:US
Practice Address - Phone:321-622-6290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH21669101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health