=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528546660
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEGHAN MCCARVILLE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2018
-----------------------------------------------------
Last Update Date | 04/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8 S MICHIGAN AVE STE 2300
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60603-3357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-980-9499
-----------------------------------------------------
Fax | 312-668-8578
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5008 VERNON PARK PL
-----------------------------------------------------
City | LISLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60532-3508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-955-5506
-----------------------------------------------------
Fax | 312-668-8578
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LMFT
-----------------------------------------------------
Name | MRS. MEGHAN MCCARVILLE
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 773-980-9499
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 166.001205
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------