Healthcare Provider Details

I. General information

NPI: 1174213003
Provider Name (Legal Business Name): MEGAN LYNAE MCCARTHY CADC II CRM II QMHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN LYNAE MURPHY CADC II CRM II QMHA

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 09/14/2024
Certification Date: 09/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 COLLEGE ST
PHILOMATH OR
97370-9534
US

IV. Provider business mailing address

2004 COLLEGE ST
PHILOMATH OR
97370-9534
US

V. Phone/Fax

Practice location:
  • Phone: 541-740-1650
  • Fax:
Mailing address:
  • Phone: 541-740-1650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15-12-15
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number24-CRM-II-0291
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: