MEDICARE: DR. MEGHAN LORAYNE GOULET PSYD

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	103TC0700X	Clinical Psychologist	PSY33727	CA

General Provider Information

NPI Number	:	1740997345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEGHAN LORAYNE GOULET PSYD

Provider Business Mailing Address
First Line	:	9828 ASPEN GROVE PL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6621
Country	:	US
Telephone Number	:	951-816-5058
Fax Number	:

Provider Business Practice Location Address
First Line	:	9828 ASPEN GROVE PL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6621
Country	:	US
Telephone Number	:	951-816-5058
Fax Number	:

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

Provider Enumeration Date	:	11/02/2022
Last Update Date	:	11/02/2022

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