Provider Demographics
NPI:1831234194
Name:WHITLEY, MEGAN JO (LPC, LSSP)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:JO
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:LPC, LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4645 SWEETWATER BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3136
Mailing Address - Country:US
Mailing Address - Phone:713-412-3487
Mailing Address - Fax:
Practice Address - Street 1:4645 SWEETWATER BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3136
Practice Address - Country:US
Practice Address - Phone:713-412-3487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17799101YP2500X
TX3-2098103TS0200X
KS103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool