=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447558051
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN HART MA LLP CAADC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2011
-----------------------------------------------------
Last Update Date | 05/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 141 E CENTER ST
-----------------------------------------------------
City | PETERSBURG
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49270-9701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-395-6349
-----------------------------------------------------
Fax | 248-483-7868
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 141 E CENTER ST
-----------------------------------------------------
City | PETERSBURG
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49270-9701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-395-6349
-----------------------------------------------------
Fax | 248-483-7868
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 6301014646
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 6361004514
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | C-02623
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------