Healthcare Provider Details

I. General information

NPI: 1104601673
Provider Name (Legal Business Name): MEGAN SOUTHWARD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 6TH ST
WASHINGTON COURT HOUSE OH
43160-2515
US

IV. Provider business mailing address

320 6TH ST
WASHINGTON COURT HOUSE OH
43160-2515
US

V. Phone/Fax

Practice location:
  • Phone: 740-606-2097
  • Fax:
Mailing address:
  • Phone: 740-606-2097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2507742
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: