Healthcare Provider Details

I. General information

NPI: 1578425195
Provider Name (Legal Business Name): MEGAN ELIZABETH FENNELL CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 PINE ST
BRISTOL VT
05443-1043
US

IV. Provider business mailing address

42 MUNSILL AVE APT E
BRISTOL VT
05443-1221
US

V. Phone/Fax

Practice location:
  • Phone: 802-453-6818
  • Fax:
Mailing address:
  • Phone: 843-518-0592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number097.0136143
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: