Provider Demographics
NPI:1023577152
Name:BAGBY, MEGAN LATRICE
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LATRICE
Last Name:BAGBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 POTRERO CIR
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-4143
Mailing Address - Country:US
Mailing Address - Phone:707-430-5083
Mailing Address - Fax:
Practice Address - Street 1:1385 N HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-8276
Practice Address - Country:US
Practice Address - Phone:415-382-3363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor