Provider Demographics
NPI:1144902230
Name:LOCKE, MEAGAN (LCSW)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:LOCKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 IDAHO ST UNIT E
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-1472
Mailing Address - Country:US
Mailing Address - Phone:406-830-6480
Mailing Address - Fax:
Practice Address - Street 1:101 E BROADWAY ST STE 317
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4510
Practice Address - Country:US
Practice Address - Phone:406-830-6480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 101YA0400X
MTBBH-LCSW-LIC-702431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)