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NPI Code Detail

MEDICARE: MEGAN IVANOFF MHPC

MEDICARE: MEGAN IVANOFF MHPC
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
1101YM0800XMental Health CounselorAK

General Provider Information

NPI Number : 1376334847
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEGAN IVANOFF MHPC
Provider Business Mailing Address
First Line : PO BOX 31001-4162
Second Line :
City : PASADENA
State : CA
Zip : 91110-4162
Country : US
Telephone Number : 866-747-2455
Fax Number :
Provider Business Practice Location Address
First Line : 1818 E REZANOF DR
Second Line :
City : KODIAK
State : AK
Zip : 99615-6505
Country : US
Telephone Number : 907-481-2400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2025
Last Update Date : 05/06/2026

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