Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ACD.0001323 | CO |
N | 101YM0800X | Mental Health Counselor | LPC.0015773 | CO |
NPI | 1003290321 |
---|---|
Provider Name | Megan Hanekom |
First Address | Thornton, CO 80260-6880 |
Second Address | Thornton, CO 80260-6880 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2015 |
Last Update Date | 25/01/2021 |