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General NPI Number Information
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NPI Number | 1144857301
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Entity Type | Individual
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Provider Name | MEGAN STAHLY LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 03/26/2020
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Provider Practice Location Address
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Address Line | 827 W 14TH CT
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City | BLOOMINGTON
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State | IN
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Zip | 47404-3347
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Country | US
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Telephone | 812-339-3429
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Fax |
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Provider Business Mailing Address
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Address Line | 3322 S BROWNING PL
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City | BLOOMINGTON
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State | IN
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Zip | 47401-9472
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Country | US
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Telephone | 812-679-9149
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34008409A
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License Number State | IN
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