Healthcare Provider Details

I. General information

NPI: 1679062285
Provider Name (Legal Business Name): MEGAN DOOLEY HUSSMANN LPC, PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 11/27/2022
Certification Date: 11/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 LAFAYETTE AVE
SAINT LOUIS MO
63104-2508
US

IV. Provider business mailing address

1804 LAFAYETTE AVE
SAINT LOUIS MO
63104-2508
US

V. Phone/Fax

Practice location:
  • Phone: 314-669-6242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2017035090
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: