MEDICARE: MEGAN HENRY

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	106S00000X	Behavior Technician	RBT-22-213633	AR
2	103K00000X	Behavior Analyst	1-25-80294	AR

General Provider Information

NPI Number	:	1972199842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN HENRY

Provider Business Mailing Address
First Line	:	3025 FOUNTAIN DR STE 100
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-3690
Country	:	US
Telephone Number	:	501-269-1656
Fax Number	:	501-325-1255

Provider Business Practice Location Address
First Line	:	3025 FOUNTAIN DR STE 100
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-3690
Country	:	US
Telephone Number	:	501-269-1656
Fax Number	:	501-325-1255

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

Provider Enumeration Date	:	12/15/2020
Last Update Date	:	04/03/2025

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Directions to “ MEGAN HENRY ” Practice Location

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