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General NPI Number Information
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NPI Number | 1366815722
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Entity Type | Individual
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Provider Name | MEGYN WILSON LMFT
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Gender | Female
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Dates
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Enumeration Date | 11/06/2015
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Last Update Date | 10/19/2018
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Provider Practice Location Address
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Address Line | 575 SHRINE RD
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City | SPRINGFIELD
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State | OH
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Zip | 45504-3927
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Country | US
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Telephone | 937-399-6101
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Fax |
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Provider Business Mailing Address
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Address Line | 575 SHRINE RD
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City | SPRINGFIELD
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State | OH
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Zip | 45504-3927
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Country | US
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Telephone | 937-399-6101
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | M. 1500027
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License Number State | OH
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