Provider Demographics
NPI:1104165273
Name:DAVIS, MEGAN (LCPC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 S 7TH ST E
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:MT
Mailing Address - Zip Code:59538-8871
Mailing Address - Country:US
Mailing Address - Phone:406-390-4284
Mailing Address - Fax:
Practice Address - Street 1:542 S 7TH ST E
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:MT
Practice Address - Zip Code:59538-8871
Practice Address - Country:US
Practice Address - Phone:406-390-4284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-08
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2659101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1477745370Medicaid