Basic Information
| Provider Information | |||||||||
| NPI: | 1164468609 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEHARG | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 945 11TH AVE | ||||||||
| Address2: | STE B | ||||||||
| City: | LONGVIEW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986322555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604148600 | ||||||||
| FaxNumber: | 3606367372 | ||||||||
| Practice Location | |||||||||
| Address1: | 945 11TH AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | LONGVIEW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986322503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604148600 | ||||||||
| FaxNumber: | 3606367372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 09/22/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PY00001656 | WA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 7096274 | 05 | WA | MEDICAID |