Provider Demographics
NPI:1689402505
Name:DOUGLAS, MEGAN MELINDA (TLMHC)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MELINDA
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 15TH ST N
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:IA
Mailing Address - Zip Code:50548-1008
Mailing Address - Country:US
Mailing Address - Phone:515-332-7672
Mailing Address - Fax:
Practice Address - Street 1:1000 15TH ST N
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:IA
Practice Address - Zip Code:50548-1008
Practice Address - Country:US
Practice Address - Phone:515-332-7672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA124749101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health