Provider Demographics
NPI:1063893667
Name:MEYERHOFER, MEGAN LYNN (LMFT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LYNN
Last Name:MEYERHOFER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:LYNN
Other - Last Name:VANDENBOSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:1263 MAIN ST STE 122
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302-1341
Mailing Address - Country:US
Mailing Address - Phone:920-315-8643
Mailing Address - Fax:920-214-1274
Practice Address - Street 1:1263 MAIN ST STE 122
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-1341
Practice Address - Country:US
Practice Address - Phone:920-315-8643
Practice Address - Fax:920-214-1274
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1130-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist