Provider Demographics
NPI:1609690759
Name:MCEVOY, MEGHANN (LLC)
Entity type:Individual
Prefix:
First Name:MEGHANN
Middle Name:
Last Name:MCEVOY
Suffix:
Gender:F
Credentials:LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11783 OLD OAKS DR
Mailing Address - Street 2:
Mailing Address - City:DAVISBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48350-3451
Mailing Address - Country:US
Mailing Address - Phone:248-895-0031
Mailing Address - Fax:
Practice Address - Street 1:8949 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-4246
Practice Address - Country:US
Practice Address - Phone:810-626-5191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451024011101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor