Provider Demographics
NPI:1376380345
Name:MCCOLLOW, MEAGHAN MEISSNER (PHD, BCBA-D)
Entity type:Individual
Prefix:DR
First Name:MEAGHAN
Middle Name:MEISSNER
Last Name:MCCOLLOW
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:DR
Other - First Name:MEAGHAN
Other - Middle Name:MELISSA
Other - Last Name:MCCOLLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, BCBA-D
Mailing Address - Street 1:443 CAMDEN ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2642
Mailing Address - Country:US
Mailing Address - Phone:510-421-0600
Mailing Address - Fax:
Practice Address - Street 1:6104 EVELINE ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-3012
Practice Address - Country:US
Practice Address - Phone:314-932-1105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7401002197103K00000X
MO2024025700103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst