Provider Demographics
NPI:1831817790
Name:GLENN WESTHOFF, MEGHAN ELAYNE (LAC)
Entity type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:ELAYNE
Last Name:GLENN WESTHOFF
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 S 21ST ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-2015
Mailing Address - Country:US
Mailing Address - Phone:479-215-9743
Mailing Address - Fax:
Practice Address - Street 1:1345 E HENRI DE TONTI BLVD STE C
Practice Address - Street 2:
Practice Address - City:TONTITOWN
Practice Address - State:AR
Practice Address - Zip Code:72762-9767
Practice Address - Country:US
Practice Address - Phone:479-633-7547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2109020101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor