Individual
MS. MEGAN KOSTRUBANIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, MAC
Contact information
Practice address
2420 N COLISEUM BLVD STE 206, FORT WAYNE, IN 46805-3139
(260) 223-4613
Mailing address
2420 N COLISEUM BLVD STE 206, FORT WAYNE, IN 46805-3139
(260) 223-4613
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0474
IN
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201315280A
—
IN
Enumeration date
06/07/2015
Last updated
07/21/2022
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