Provider Demographics
NPI:1962939660
Name:SMITH, MEGAN (LMHC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 131
Mailing Address - Street 2:
Mailing Address - City:ANAHOLA
Mailing Address - State:HI
Mailing Address - Zip Code:96703-0131
Mailing Address - Country:US
Mailing Address - Phone:508-314-0421
Mailing Address - Fax:
Practice Address - Street 1:4-1629 KUHIO HWY
Practice Address - Street 2:SUITE C1
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746
Practice Address - Country:US
Practice Address - Phone:808-400-0047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00861101YM0800X
MA9602101YM0800X
HI103K00000X
HIMHC525101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst