Healthcare Provider Details

I. General information

NPI: 1033532114
Provider Name (Legal Business Name): MARIE ANNA MEGAHAN M.A. IN COUNSELING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIE YESTREPSKY

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8062 ORTONVILLE RD
CLARKSTON MI
48348-4456
US

IV. Provider business mailing address

5980 S MAIN ST STE 101
CLARKSTON MI
48346-2377
US

V. Phone/Fax

Practice location:
  • Phone: 248-625-2970
  • Fax:
Mailing address:
  • Phone: 248-625-2970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401014114
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: