Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | LAC13605 | AZ |
NPI | 1003125972 |
---|---|
Provider Name | Megan Feeney |
First Address | Mesa, AZ 85207-6131 |
Second Address | Mesa, AZ 85206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2010 |
Last Update Date | 27/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
792318 | (05) | AZ |