Basic Information
| Provider Information | |||||||||
| NPI: | 1003039553 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 645 S ROGERS ST | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474032353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123391691 | ||||||||
| FaxNumber: | 8123372438 | ||||||||
| Practice Location | |||||||||
| Address1: | 1443 CORPORATE WAY | ||||||||
| Address2: | |||||||||
| City: | SEYMOUR | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472743391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8125224341 | ||||||||
| FaxNumber: | 8123788367 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 01/26/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 34005502A | IN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.