=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033462676
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGHAN MARIE TRA L.S.W.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2012
-----------------------------------------------------
Last Update Date | 10/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 241 BROAD ST
-----------------------------------------------------
City | MONTOURSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17754-2283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-329-0196
-----------------------------------------------------
Fax | 570-368-8402
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 241 BROAD ST
-----------------------------------------------------
City | MONTOURSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17754-2283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 31000034
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------