Provider Demographics
NPI:1003398868
Name:HIGINBOTHAM, MEGAN KAY (PHD)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:KAY
Last Name:HIGINBOTHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25550 HAWTHORNE BLVD STE 316
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6832
Mailing Address - Country:US
Mailing Address - Phone:424-757-4344
Mailing Address - Fax:
Practice Address - Street 1:25550 HAWTHORNE BLVD STE 316
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6832
Practice Address - Country:US
Practice Address - Phone:424-757-4344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities