Provider Demographics
NPI:1114485174
Name:OCHOA, MEGAN RAE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:RAE
Last Name:OCHOA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14614 VANCE JACKSON RD APT 1103
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3237
Mailing Address - Country:US
Mailing Address - Phone:956-371-4445
Mailing Address - Fax:
Practice Address - Street 1:121 OLD SAN ANTONIO RD
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-3415
Practice Address - Country:US
Practice Address - Phone:830-816-2425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76526101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX76526OtherTEXAS LICENSE NUMBER