Provider Demographics
NPI:1952958431
Name:HUSTON, MEGAN MANDA (LPC, CDCA)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MANDA
Last Name:HUSTON
Suffix:
Gender:F
Credentials:LPC, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5852 SHETLAND CIR NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721-3945
Mailing Address - Country:US
Mailing Address - Phone:330-495-6696
Mailing Address - Fax:
Practice Address - Street 1:919 2ND ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44704-1132
Practice Address - Country:US
Practice Address - Phone:330-454-7919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health