Healthcare Provider Details

I. General information

NPI: 1518349406
Provider Name (Legal Business Name): MEGHAN K. FALLON M. ED. LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 SCHOOL STREET
HARTFORD VT
05047-0709
US

IV. Provider business mailing address

390 RIVER STREET
SPRINGFIELD VT
05156-2226
US

V. Phone/Fax

Practice location:
  • Phone: 802-295-3031
  • Fax: 802-295-0820
Mailing address:
  • Phone: 802-886-4500
  • Fax: 802-886-4560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0134173
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number097.0129083
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: