Provider Demographics
NPI:1215245931
Name:BLAYLOCK, MEGGAN HANSON (MS)
Entity type:Individual
Prefix:MRS
First Name:MEGGAN
Middle Name:HANSON
Last Name:BLAYLOCK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MEGGAN
Other - Middle Name:HANSON
Other - Last Name:BARCLAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:372 GREENO RD S
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1916
Mailing Address - Country:US
Mailing Address - Phone:251-990-4190
Mailing Address - Fax:251-928-0126
Practice Address - Street 1:1203 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5327
Practice Address - Country:US
Practice Address - Phone:662-234-7601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health