Provider Demographics
NPI:1306910062
Name:SHARE, MEGAN (MA, LCPC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:SHARE
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 W PETERSON AVE
Mailing Address - Street 2:SUITE 409
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5712
Mailing Address - Country:US
Mailing Address - Phone:773-801-8701
Mailing Address - Fax:866-514-1075
Practice Address - Street 1:4747 W PETERSON AVE
Practice Address - Street 2:SUITE 409
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5712
Practice Address - Country:US
Practice Address - Phone:773-801-8701
Practice Address - Fax:866-514-1075
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006708101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional