Basic Information
| Provider Information | |||||||||
| NPI: | 1356777080 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEGGINSON | ||||||||
| FirstName: | MAEGAN | ||||||||
| MiddleName: | CARNEW | ||||||||
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| Credential: | MA, LMFT, LPC, CST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 NE HOLMAN ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972114851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8326654640 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2923 NE BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039410856 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2013 | ||||||||
| LastUpdateDate: | 06/09/2019 | ||||||||
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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 | 106H00000X | 202072 | TX | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.