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General NPI Number Information
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NPI Number | 1467273219
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Entity Type | Organization
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Legal Business Name | MEGAN ELIZABETH SMITH
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 444 STILLWATER AVE STE 104
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City | BANGOR
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State | ME
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Zip | 04401-3500
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Country | US
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Telephone | 207-951-6493
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Fax |
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Provider Business Mailing Address
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Address Line | 56 HUGHES BLVD
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City | HAMPDEN
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State | ME
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Zip | 04444-1046
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Country | US
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Telephone | 207-951-6493
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Fax |
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Authorized Official
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Title or Position | CLINICAL THERAPIST
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Name | MRS. MEGAN ELIZABETH SMITH
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Credential | LCPC
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Telephone | 207-952-6493
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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