Provider Demographics
NPI:1336531631
Name:BAX, MEGAN ELIZABETH (MSW/LCSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:BAX
Suffix:
Gender:F
Credentials:MSW/LCSW
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:MOEHRLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2650 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1489
Mailing Address - Country:US
Mailing Address - Phone:143-716-5003
Mailing Address - Fax:314-371-6508
Practice Address - Street 1:12141 LADUE RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8120
Practice Address - Country:US
Practice Address - Phone:314-878-4340
Practice Address - Fax:314-842-2552
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018036486104100000X
IN34007929A1041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker