Healthcare Provider Details

I. General information

NPI: 1881986719
Provider Name (Legal Business Name): MEGAN JOSEPH FREEMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 LINDELL RD
LAS VEGAS NV
89146-6815
US

IV. Provider business mailing address

6171 W CHARLESTON BLVD BUILDING 10
LAS VEGAS NV
89146-1126
US

V. Phone/Fax

Practice location:
  • Phone: 702-253-2806
  • Fax:
Mailing address:
  • Phone: 702-486-5282
  • Fax: 702-486-9653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number53 921
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPYT140731
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY0752
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: