Basic Information
Provider Information
NPI: 1962560532
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SNOW
FirstName: MEGAN
MiddleName: LEE
NamePrefix: MRS.
NameSuffix:  
Credential: LPC, CADC-1
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 82819
Address2:  
City: PORTLAND
State: OR
PostalCode: 97282
CountryCode: US
TelephoneNumber: 5032335405
FaxNumber: 5032332696
Practice Location
Address1: 21210 NW MAUZEY RD
Address2:  
City: HILLSBORO
State: OR
PostalCode: 97124
CountryCode: US
TelephoneNumber: 5034399531
FaxNumber: 5035313841
Other Information
ProviderEnumerationDate: 12/05/2006
LastUpdateDate: 04/09/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YA0400X  N Behavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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