Provider Demographics
NPI:1972899755
Name:RICHARDSON, MEGAN CALLAHAN (LMFT, NCC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:CALLAHAN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 W LINEBAUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-8702
Mailing Address - Country:US
Mailing Address - Phone:352-359-0687
Mailing Address - Fax:
Practice Address - Street 1:3812 W LINEBAUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-8702
Practice Address - Country:US
Practice Address - Phone:352-359-0687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8568101YP2500X
FLMT2902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional