Provider Demographics
NPI:1528647120
Name:DRIZIN, MEGAN KATHERINE (LLPC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:KATHERINE
Last Name:DRIZIN
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7817 HIGH KNOLL DR SE
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-7918
Mailing Address - Country:US
Mailing Address - Phone:616-730-2052
Mailing Address - Fax:
Practice Address - Street 1:781 KENMOOR AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8628
Practice Address - Country:US
Practice Address - Phone:616-730-2052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401019228101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty