MEDICARE: TARNYA FEGAN LCMHC, MLADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	0994	NH
2	101YM0800X	Mental Health Counselor	1127	NH

General Provider Information

NPI Number	:	1669908877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARNYA FEGAN LCMHC, MLADC

Provider Business Mailing Address
First Line	:	12 LADYSLIPPER LN
Second Line	:
City	:	SOUTH BERWICK
State	:	ME
Zip	:	03908-2205
Country	:	US
Telephone Number	:	603-498-6452
Fax Number	:

Provider Business Practice Location Address
First Line	:	2456 LAFAYETTE RD
Second Line	:	SUITE 12
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-5624
Country	:	US
Telephone Number	:	603-498-6452
Fax Number	:

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

Provider Enumeration Date	:	05/08/2017
Last Update Date	:	05/08/2017

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