Provider Demographics
NPI:1730817867
Name:MCGUGAN, MEGAN (PHD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MCGUGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 IBIS WALK PL N UNIT 2409
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-3858
Mailing Address - Country:US
Mailing Address - Phone:740-704-1664
Mailing Address - Fax:
Practice Address - Street 1:1101 DAVIS ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5945
Practice Address - Country:US
Practice Address - Phone:844-475-3379
Practice Address - Fax:855-644-2981
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10916103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical