Basic Information
| Provider Information | |||||||||
| NPI: | 1225209190 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MERRIWETHER | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PH.D., CDP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15418 MAIN ST | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | MILL CREEK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980129030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253395453 | ||||||||
| FaxNumber: | 4252258028 | ||||||||
| Practice Location | |||||||||
| Address1: | 15418 MAIN ST | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | MILL CREEK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980129030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253395453 | ||||||||
| FaxNumber: | 4252258028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2008 | ||||||||
| LastUpdateDate: | 01/02/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CP00005868 | WA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 103TC0700X | PY 00003905 | WA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.