Provider Demographics
NPI:1063790442
Name:SEAHOLM, MEGAN BROOKE (LMSW)
Entity type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:BROOKE
Last Name:SEAHOLM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 S TOPAZ WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-4474
Mailing Address - Country:US
Mailing Address - Phone:208-888-3151
Mailing Address - Fax:208-888-0854
Practice Address - Street 1:1650 S TOPAZ WAY
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-4474
Practice Address - Country:US
Practice Address - Phone:208-888-3151
Practice Address - Fax:208-888-0854
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW31443104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker