Provider Demographics
NPI:1366740714
Name:ANDERSON, MEGHAN R (LPC, NCC)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:R
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BRECKENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-7502
Mailing Address - Country:US
Mailing Address - Phone:662-801-4088
Mailing Address - Fax:
Practice Address - Street 1:110 BRECKENRIDGE DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-7502
Practice Address - Country:US
Practice Address - Phone:662-801-4088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1567101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional