MEDICARE: DR. MANDY MEGGENS MORRILL-RICHARDS LMHC , NCC

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	101YM0800X	Mental Health Counselor	39003401A	IN

General Provider Information

NPI Number	:	1568135101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANDY MEGGENS MORRILL-RICHARDS LMHC , NCC

Provider Business Mailing Address
First Line	:	711 E OAK ST
Second Line	:
City	:	PORTER
State	:	IN
Zip	:	46304-3174
Country	:	US
Telephone Number	:	267-566-0880
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 BERTHOLET BLVD STE 301
Second Line	:
City	:	VALPARAISO
State	:	IN
Zip	:	46383-7959
Country	:	US
Telephone Number	:	219-323-3311
Fax Number	:

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

Provider Enumeration Date	:	07/29/2021
Last Update Date	:	07/29/2021

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