Healthcare Provider Details

I. General information

NPI: 1598407751
Provider Name (Legal Business Name): XAHARA ALEXANDRIA MEGOD MA, LCPC, R-DMT, CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 W JACKSON ST APT 8
MACOMB IL
61455-3635
US

IV. Provider business mailing address

1515 W JACKSON ST APT 8
MACOMB IL
61455-3635
US

V. Phone/Fax

Practice location:
  • Phone: 309-252-0501
  • Fax:
Mailing address:
  • Phone: 309-252-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: