Provider Demographics
NPI:1194550103
Name:GAVIN, MEGAN (PHD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:
Last Name:GAVIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 W TOMBSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-5449
Mailing Address - Country:US
Mailing Address - Phone:928-266-3913
Mailing Address - Fax:
Practice Address - Street 1:16 E ROUTE 66 STE 203
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-5777
Practice Address - Country:US
Practice Address - Phone:928-606-2907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ004101103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty