Provider Demographics
NPI:1972806933
Name:MACKETY, MEGAN LEE (LLMSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEE
Last Name:MACKETY
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 CLAYTON CT
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1107
Mailing Address - Country:US
Mailing Address - Phone:616-780-2605
Mailing Address - Fax:
Practice Address - Street 1:167 CLAYTON CT
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1107
Practice Address - Country:US
Practice Address - Phone:616-204-2032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010913151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical