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General NPI Number Information
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NPI Number | 1548030596
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Entity Type | Organization
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Legal Business Name | MEGAN GROVE COUNSELING, PLLC
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Dates
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Enumeration Date | 01/02/2024
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 1254 N GALENA AVE
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City | DIXON
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State | IL
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Zip | 61021-1047
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Country | US
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Telephone | 815-973-8160
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Fax |
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Provider Business Mailing Address
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Address Line | 1805 WHITE PINES DR
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City | DIXON
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State | IL
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Zip | 61021-8790
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Country | US
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Telephone | 815-973-8160
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MEGAN E GROVE
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Credential | LCSW
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Telephone | 815-973-8160
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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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