Provider Demographics
NPI:1083167233
Name:MEACHAM, JAMIE MAE (BCBA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MAE
Last Name:MEACHAM
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92842-0776
Mailing Address - Country:US
Mailing Address - Phone:714-623-3597
Mailing Address - Fax:
Practice Address - Street 1:12682 PLEASANT PL
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-4939
Practice Address - Country:US
Practice Address - Phone:714-623-3597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-24
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BCBA 1-16-22304103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst