Provider Demographics
NPI:1588420632
Name:BLACKFORD, MEGAN EMILY (PLPC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:EMILY
Last Name:BLACKFORD
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6425 EAGLE XING
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-9812
Mailing Address - Country:US
Mailing Address - Phone:502-645-9673
Mailing Address - Fax:
Practice Address - Street 1:6425 EAGLE XING
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-9812
Practice Address - Country:US
Practice Address - Phone:502-645-9673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor