Basic Information
Provider Information | |||||||||
NPI: | 1033592266 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCSHANE | ||||||||
FirstName: | MEGHANN | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MSSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MCSHANE | ||||||||
OtherFirstName: | MEGHANN | ||||||||
OtherMiddleName: | MARIE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MSSW | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 1923 SULPHUR SPRINGS RD | ||||||||
Address2: |   | ||||||||
City: | MORRISTOWN | ||||||||
State: | TN | ||||||||
PostalCode: | 378135654 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4233179344 | ||||||||
FaxNumber: | 4237142355 | ||||||||
Practice Location | |||||||||
Address1: | 2018 WESTERN AVE | ||||||||
Address2: |   | ||||||||
City: | KNOXVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 379215718 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8655440406 | ||||||||
FaxNumber: | 8655440480 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/07/2015 | ||||||||
LastUpdateDate: | 09/28/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/29/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X |   |   | Y |   | Other Service Providers | Case Manager/Care Coordinator |   | 104100000X |   | TN | N |   | Behavioral Health & Social Service Providers | Social Worker |   |
No ID Information.