Basic Information
| Provider Information | |||||||||
| NPI: | 1861903361 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JANUSHANIS | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | CHRISTINE | ||||||||
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| Credential: | PLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3115 S GRAND BLVD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631181034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145770444 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3115 S GRAND BLVD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631181034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145770444 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2017 | ||||||||
| LastUpdateDate: | 12/10/2018 | ||||||||
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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 | 101YM0800X | 2017036325 | MO | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.