MEDICARE: MS. MEGAN MIRZA

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	101YM0800X	Mental Health Counselor	6801105494	MI

General Provider Information

NPI Number	:	1700434735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MEGAN MIRZA

Provider Business Mailing Address
First Line	:	100 BILLINGSGATE CT
Second Line	:
City	:	BLOOMFIELD
State	:	MI
Zip	:	48301-1600
Country	:	US
Telephone Number	:	248-882-0080
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 BILLINGSGATE CT
Second Line	:
City	:	BLOOMFIELD
State	:	MI
Zip	:	48301-1600
Country	:	US
Telephone Number	:	248-882-0080
Fax Number	:

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

Provider Enumeration Date	:	09/03/2019
Last Update Date	:	05/07/2024

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