Basic Information
| Provider Information | |||||||||
| NPI: | 1962643064 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YORK | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | THOMPSON AND MCCORMACK | ||||||||
| OtherFirstName: | MEGAN | ||||||||
| OtherMiddleName: | ELIZABETH | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LCSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10712 COUNTY ROAD 8130 | ||||||||
| Address2: | |||||||||
| City: | WEST PLAINS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657755784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4175059843 | ||||||||
| FaxNumber: | 4172564858 | ||||||||
| Practice Location | |||||||||
| Address1: | 203 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WEST PLAINS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657753524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4175059843 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2009 | ||||||||
| LastUpdateDate: | 08/21/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2006018050 | MO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 2006018050 | 05 | MO | MEDICAID | 612447 | 01 | MO | BLUE CROSS BLUE SHIELD | OTHER |