Healthcare Provider Details

I. General information

NPI: 1154065464
Provider Name (Legal Business Name): MEGAN KELLEY CARR HLAVAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8809 CINCINNATI DAYTON RD
WEST CHESTER OH
45069-3134
US

IV. Provider business mailing address

8809 CINCINNATI DAYTON RD
WEST CHESTER OH
45069-3134
US

V. Phone/Fax

Practice location:
  • Phone: 513-227-1628
  • Fax:
Mailing address:
  • Phone: 513-227-1628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.0900261
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: