Healthcare Provider Details

I. General information

NPI: 1518485242
Provider Name (Legal Business Name): MEAGHAN CLAIRE PUCKETT LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 WENTWORTH AVE E STE 210
WEST ST PAUL MN
55118
US

IV. Provider business mailing address

1701 AMERICAN BLVD E STE 4
BLOOMINGTON MN
55425-1402
US

V. Phone/Fax

Practice location:
  • Phone: 612-676-1604
  • Fax: 612-379-8235
Mailing address:
  • Phone: 612-676-1604
  • Fax: 612-379-8325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3000
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: