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NPI Code Detail

MEDICARE: ELISE NATHALIE MEGER

MEDICARE: ELISE NATHALIE MEGER
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 Counselor

General Provider Information

NPI Number : 1538775143
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISE NATHALIE MEGER
Provider Business Mailing Address
First Line : 130 GROVELAND TER
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55403-1148
Country : US
Telephone Number : 612-268-4777
Fax Number :
Provider Business Practice Location Address
First Line : 3033 EXCELSIOR BLVD STE 215
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55416-5274
Country : US
Telephone Number : 612-268-4777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2020
Last Update Date : 09/28/2020

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