Healthcare Provider Details

I. General information

NPI: 1376147074
Provider Name (Legal Business Name): MEGAN CLARICE SHOOK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3265 INTERTECH DR
ANGOLA IN
46703-7325
US

IV. Provider business mailing address

3265 INTERTECH DR
ANGOLA IN
46703-7325
US

V. Phone/Fax

Practice location:
  • Phone: 260-665-9494
  • Fax:
Mailing address:
  • Phone: 260-665-9494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39006161A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: