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General NPI Number Information
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NPI Number | 1841647088
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Entity Type | Individual
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Provider Name | MEGAN BLUE LCSW-S
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Gender | Female
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 12/09/2022
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Provider Practice Location Address
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Address Line | 15329 WAGON WHEEL CIR
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City | CHANDLER
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State | TX
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Zip | 75758-6989
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Country | US
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Telephone | 281-435-5902
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Fax |
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Provider Business Mailing Address
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Address Line | 4524 POST OAK RD
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City | NACOGDOCHES
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State | TX
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Zip | 75965-0937
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 57235
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License Number State | TX
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