Healthcare Provider Details

I. General information

NPI: 1730817867
Provider Name (Legal Business Name): MEGAN MCGUGAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 DAVIS ST
EVANSTON IL
60201-5945
US

IV. Provider business mailing address

871 IBIS WALK PL N UNIT 2409
SAINT PETERSBURG FL
33716-3858
US

V. Phone/Fax

Practice location:
  • Phone: 844-475-3379
  • Fax: 855-644-2981
Mailing address:
  • Phone: 740-704-1664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY10916
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPY10916
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: