Provider Demographics
NPI:1730728486
Name:RICHERT, MEGAN ELISE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ELISE
Last Name:RICHERT
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 1:487 DIXSON ST
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3746
Mailing Address - Country:US
Mailing Address - Phone:805-305-0278
Mailing Address - Fax:
Practice Address - Street 1:867 PACIFIC ST STE 220
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-6313
Practice Address - Country:US
Practice Address - Phone:805-774-0656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-29
Last Update Date:2019-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA680631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical