Basic Information
| Provider Information | |||||||||
| NPI: | 1407477615 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEARY | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCPC NCC CADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 524 W DIVERSEY PKWY APT 2 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606143937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484219839 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 15419 E 127TH ST # 5 | ||||||||
| Address2: | |||||||||
| City: | LEMONT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604396494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307777113 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2020 | ||||||||
| LastUpdateDate: | 04/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.