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NPI Code Detail

MEDICARE: MEGHANN FAY TYCAST

MEDICARE: MEGHANN FAY TYCAST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorOH
2171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104110634
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEGHANN FAY TYCAST
Provider Business Mailing Address
First Line : 1865 N RIDGE RD E STE A
Second Line :
City : LORAIN
State : OH
Zip : 44055-3359
Country : US
Telephone Number : 440-324-1300
Fax Number :
Provider Business Practice Location Address
First Line : 1865 N RIDGE RD E STE A
Second Line :
City : LORAIN
State : OH
Zip : 44055-3359
Country : US
Telephone Number : 440-324-1300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2011
Last Update Date : 12/01/2023

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Directions to “ MEGHANN FAY TYCAST ” Practice Location

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