Provider Demographics
NPI:1861968422
Name:BURCL, MEGHAN (LCSW, CADC)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:BURCL
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7146 183RD ST STE 123
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3933
Mailing Address - Country:US
Mailing Address - Phone:708-314-8416
Mailing Address - Fax:
Practice Address - Street 1:7146 183RD ST STE 123
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3933
Practice Address - Country:US
Practice Address - Phone:872-760-4771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0237531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL362170821-062Medicaid