MEDICARE: MEGAN GAUGHAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1013635341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN GAUGHAN

Provider Business Mailing Address
First Line	:	PO BOX 748465
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-8465
Country	:	US
Telephone Number	:	855-284-7483
Fax Number	:	617-807-0958

Provider Business Practice Location Address
First Line	:	3129 TILTON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-5816
Country	:	US
Telephone Number	:	855-284-7483
Fax Number	:	617-807-0958

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2022
Last Update Date	:	08/22/2022

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Directions to “ MEGAN GAUGHAN ” Practice Location

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