Provider Demographics
NPI:1164753398
Name:BAUSCH, MEGAN CLEMENTINE (MS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:CLEMENTINE
Last Name:BAUSCH
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Gender:F
Credentials:MS, BCBA
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Mailing Address - Street 1:36468 EMERALD COAST PKWY
Mailing Address - Street 2:SUITE 2101
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-4799
Mailing Address - Country:US
Mailing Address - Phone:850-837-1200
Mailing Address - Fax:850-269-2341
Practice Address - Street 1:36468 EMERALD COAST PKWY
Practice Address - Street 2:SUITE 2101
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-4799
Practice Address - Country:US
Practice Address - Phone:850-837-1200
Practice Address - Fax:850-269-2341
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL1-09-6042103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst