Provider Demographics
NPI:1306916044
Name:MEEGAN, WILLIAM J (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:MEEGAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 SAYRE AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2317
Mailing Address - Country:US
Mailing Address - Phone:859-252-1792
Mailing Address - Fax:859-259-1301
Practice Address - Street 1:637 SAYRE AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2317
Practice Address - Country:US
Practice Address - Phone:859-252-1792
Practice Address - Fax:859-259-1301
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0263103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYB12914OtherVALUE BEHAVIORAL HEALTH
KYK00831OtherTRICARE
KY044587OtherVALUE OPTIONS
KYB12914OtherVALUE BEHAVIORAL HEALTH
S39851Medicare UPIN