Basic Information
| Provider Information | |||||||||
| NPI: | 1306582143 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MEGEN RHINE CONSULTING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19764 S 4190 RD | ||||||||
| Address2: | |||||||||
| City: | CLAREMORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740174473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186884593 | ||||||||
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| Practice Location | |||||||||
| Address1: | 19764 S 4190 RD | ||||||||
| Address2: | |||||||||
| City: | CLAREMORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740174473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186884593 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2022 | ||||||||
| LastUpdateDate: | 05/06/2022 | ||||||||
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| AuthorizedOfficialLastName: | RHINE | ||||||||
| AuthorizedOfficialFirstName: | MEGEN | ||||||||
| AuthorizedOfficialMiddleName: | CALLI | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9186884593 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LPC-S | ||||||||
| NPICertificationDate: | 05/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.