Provider Demographics
NPI:1962190371
Name:MEGHAN TEGTMEIER, LICENSED CLINICAL SOCIAL WORKER PC
Entity type:Organization
Organization Name:MEGHAN TEGTMEIER, LICENSED CLINICAL SOCIAL WORKER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:TEGTMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-337-3125
Mailing Address - Street 1:313 BRILLIANT SUMMIT CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2374
Mailing Address - Country:US
Mailing Address - Phone:701-640-3593
Mailing Address - Fax:
Practice Address - Street 1:313 BRILLIANT SUMMIT CIR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2374
Practice Address - Country:US
Practice Address - Phone:701-640-3593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty