Basic Information
| Provider Information | |||||||||
| NPI: | 1952937757 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEGENHARDT | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | ALAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 631 MARGUERITE AVE | ||||||||
| Address2: | |||||||||
| City: | CUYAHOGA FALLS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442211929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303224765 | ||||||||
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| Practice Location | |||||||||
| Address1: | 205 WADSWORTH RD | ||||||||
| Address2: | |||||||||
| City: | WADSWORTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442819580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2342178882 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2020 | ||||||||
| LastUpdateDate: | 03/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.