MEDICARE: MRS. MEGAN CLAIRE WALLACE BRIDGES ALC

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	101YP2500X	Professional Counselor	ALC04794	AL

General Provider Information

NPI Number	:	1568290245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEGAN CLAIRE WALLACE BRIDGES ALC

Provider Business Mailing Address
First Line	:	507 ROY PARRIS ROAD
Second Line	:
City	:	JACKSONVILLE
State	:	AL
Zip	:	36265-8105
Country	:	US
Telephone Number	:	256-365-8668
Fax Number	:	256-241-4833

Provider Business Practice Location Address
First Line	:	1505 PELHAM RD S STE 7
Second Line	:
City	:	JACKSONVILLE
State	:	AL
Zip	:	36265-3707
Country	:	US
Telephone Number	:	256-343-9717
Fax Number	:

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

Provider Enumeration Date	:	07/23/2024
Last Update Date	:	04/05/2025

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Directions to “ MRS. MEGAN CLAIRE WALLACE BRIDGES ALC” Practice Location

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