MEDICARE: MRS. MEGAN ELIZABETH DINNEL LMFT

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
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1164706669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEGAN ELIZABETH DINNEL LMFT

Provider Business Mailing Address
First Line	:	PO BOX 948
Second Line	:
City	:	TAHLEQUAH
State	:	OK
Zip	:	74465-0948
Country	:	US
Telephone Number	:	405-606-9992
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 POINTE PARKWAY BLVD
Second Line	:	SUITE B
City	:	YUKON
State	:	OK
Zip	:	73099-0600
Country	:	US
Telephone Number	:	405-606-9992
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2011
Last Update Date	:	03/17/2020

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