Provider Demographics
NPI:1912913336
Name:SPINKS, MEGAN W (LCSW)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:W
Last Name:SPINKS
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 1:6530 CONSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-1550
Mailing Address - Country:US
Mailing Address - Phone:260-459-0990
Mailing Address - Fax:260-459-0852
Practice Address - Street 1:6530 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1550
Practice Address - Country:US
Practice Address - Phone:260-459-0990
Practice Address - Fax:260-459-0852
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004069A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000325002OtherANTHEM PIN
IN476925000OtherMAGELLAN
IN4344040OtherCIGNA
IN360007OtherMHN
IN7170222OtherAETNA