Healthcare Provider Details

I. General information

NPI: 1821494881
Provider Name (Legal Business Name): MEGHAN COLLEY PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2014
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2860 NORTHPARK AVE
HUNTINGTON IN
46750-9700
US

IV. Provider business mailing address

2621 E JEFFERSON ST
WARSAW IN
46580-3880
US

V. Phone/Fax

Practice location:
  • Phone: 260-356-2875
  • Fax: 260-358-0611
Mailing address:
  • Phone: 574-267-7169
  • Fax: 574-269-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042752A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: